THE MAN WHO MISTOOK HIS WIFE FOR A HAT1
Dr P. was a musician of distinction, well-known for many years as a singer, and then at the local School of Music, as a teacher. It was here, in relation to his students, that certain strange problems were first observed. Sometimes a student would present himself, and Dr P. would not recognise him; or, specifically, would not recognise his face. The moment the student spoke, he would be recognised by his voice. Such incidents multiplied, causing embarrassment, perplexity, fear - and, sometimes, comedy. For not only did Dr P. increasingly fail to see faces, but he saw faces when there were no faces to see: genially, when in the street, he might pat the heads of water-hydrants and parking-meters, taking these to be the heads of children; he would amiably address carved knobs on the furniture and be astounded when they did not reply.
The notion of there being 'something the matter' did not emerge until some three years later, when diabetes developed. Well aware that diabetes could affect his eyes, Dr P. consulted an ophthalmologist, who took a careful history and examined his eyes closely. 'There's nothing the matter with your eyes,' the doctor concluded. 'But there is trouble with the visual parts of your brain.
You don't need my help, you must see a neurologist.' And so, as a result of this referral Dr P. came to me.
It was obvious within a few seconds of meeting him that there was no trace of dementia in the ordinary sense. He was a man of great cultivation and charm, who talked well and fluently, with imagination and humour. I couldn't think why he had been referred to our clinic.
And yet there was something a bit odd. He faced me as he spoke, was oriented towards me, and yet there was something the matter - it was difficult to formulate. He faced me with his ears, I came to think, but not with his eyes. These, instead of looking, gazing, at me, 'taking me in', in the normal way, made sudden strange fixations - on my nose, on my right ear, down to my chin, up to my right eye - as if noting (even studying) these individual features, but not seeing my whole face, its changing expressions, 'me', as a whole. I am not sure I fully realised this at the time - there was just a teasing strangeness, some failure in the normal interplay of gaze and expression. He saw me, he scanned me and yet ...
'What seems to be the matter?' I asked him at length.
'Nothing that I know of,' he replied with a smile, 'but people seem to think there's something wrong with my eyes.'
'But you don't recognise any visual problems?'
'No, not directly, but I occasionally make mistakes.'
He saw all right, but what did he see? I opened out a copy of the National Geographic Magazine, and asked him to describe some pictures in it.
His responses here were very curious. His eyes would dart from one thing to another, picking up tiny features, individual features, as they had done with my face. A striking brightness, a colour, a shape would arrest his attention and elicit comment - but in no case did he get the scene-as-a-whole.
'What is this?' I asked, holding up a glove.
'May I examine it?' he asked, and, taking it from me, he proceeded to examine it.
'A continuous surface,' he announced at last, 'infolded on itself. It appears to have' - he hesitated -'five outpouchings, if this is the word.'
'Yes,' I said cautiously. 'You have given me a description. Now tell me what it is.'
A container of some sort?'
Yes,' I said, 'and what would it contain?'
'It would contain its contents!' said Dr P., with a laugh. 'There are many possibilities. It could be a change-purse, for example, for coins of five sizes. It could....'
I interrupted the barmy flow. 'Does it not look familiar? Do you think it might contain, might fit, a part of your body?' No light of recognition dawned on his face.
No child would have the power to see and speak of 'a continuous surface ... infolded on itself, but any child, any infant, would immediately know a glove as a glove, see it as familiar, as going with a hand. Dr P. didn't. He saw nothing as familiar. Visually, he was lost in a world of lifeless abstractions.
'Well, Dr Sacks,' he said to me. 'You find me an interesting case, I perceive. Can you tell me what you find wrong, make recommendations?'
'I can't tell you what I find wrong,' I replied, 'but I'll say what I find right. You are a wonderful musician, and music is your life. What I would prescribe, in a case such as yours, is a life which consists entirely of music. Music has been the centre, now make it the whole, of your life.'
(Extracts from "The Man Who Mistook His Wife for a Hat and other clinical tales" by Oliver Sacks)