“Neema Notes” The Man Who Mistook His Wife for a Hat

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PART 1 - LOSSES

Introduction
 The study of the relationship between brain and mind began with Broca in 1861 with a left hemisphere
damaged patient resulting in aphasia.
 Freud felt that simply mapping certain functions to certain areas was too simple and there was an “equally
complex physiological basis” for all mental performances.
 A new science of brain/mind that Freud envisaged came in the Second World War in Russia with Luria.
 For the most part the study of neurology has been strictly based on studies of the left hemisphere.
o This is because syndromes resulting from right hemisphere damage are less distinct.
o The left hemisphere is for more sophisticated and specialized functions while the right hemisphere
was for the primitive ability to “recognize reality.”
 Right-hemisphere lesions are just as common as left, but there are over a 1000 left lesion studies for every right
lesion study.
 Luria said that despite how it is ignored, the right hemisphere is of fundamental importance because it demands
a new “romantic” science that is different from rigidity of past neurology.
 Brain deficits or diseases should be viewed as problems caused from trying to restore, replace and compensate
rather than mere losses of brain function.
 The general notion that any brain damage removes the “abstract and categorical attitude” reducing the
individual from the emotional to the concrete is wrong.
o The man who mistook his wife for a hat is a clear example because he does the opposite.

CHAPTER 1: The Man Who Mistook His Wife for a Hat

 Dr. P was a musician of distinction, talked well and fluently with imagination and humor.
 He had lost the ability to identify familiar faces (even his own), common objects such as a shoe, his foot,
gloves (which he thought might make an excellent change purse) and he even thought his wife was a hat.
 He could only identify someone if they spoke to him or there was a striking detail to identify them with.
o For instance he recognized a picture of his brother only from the square jaw and big teeth.
 He functioned precisely like a computer, constructed everything from a set of details and sometimes made
drastic errors as to what was actually there because of it.
o When he was shown the sand dune cover he thought he saw a river with a house and a terrace with
people etc. etc.
o He was a painter, and his paintings went from imaginative and visual to abstract as years went by.
 Luria’s patient Zazetsy who had lost his capacity to play games but kept his vivid imagination was the exact
opposite of Dr. P.
o Also completely unlike Zazetsky, Dr. P did not know anything was wrong and was not continually
trying to fix it.
 Dr. Sacks, the author, could do nothing more than prescribe him to immerse himself in music because it helped
him get through the day.
o Music, specifically singing for each thing, allowed him to get things done.
 Dr. P’s main problem was a lack of judgment which is the most important faculty but classic neurology often
ignores it.
o Dr. P is an example of what classic neurology has become, a computerized analysis of detail that
ignores the personal and judgmental.
 Macrae and Trolle 1956 published an almost identical case as Dr. P
o Just like Dr. P, even memories lacked visual description, he would just leave out all the visual
detail and people.
CHAPTER 2: The Lost Mariner
 Jimmie G, healthy, friendly warm, 49 years old and on intelligence testing showed excellent ability, could
solve complex problems etc.
 Full and interesting early life remembered vividly in detail with emotion, but could not remember anything
past about 1945 (when he was 19)
 Was in the navy, then in 1965 left it and lost the structure of his life leading him to heavy drinking resulting in
alcoholic destruction of the mammilary bodies that became severe in about 1971.
o Resulting in a retrograde amnesia erasing all memories after 1945, and the ability to make new
memories was lost as well.
 The only person that Jimmie is now able to recognize is his brother, these meetings are very emotional, he
loves and recognizes his brother but can't understand why he is so old.
 They tried having Jimmie write a diary but it wasn't very helpful because he kept losing his diary and because
all his entries were very unconnected and although he recognized his writing, he was indifferent towards them.
 Dr. Sacks then suggested they bring Jimmie to their recreation program because short games and puzzles kept
him very content and occupied. However, he soon could solve all the puzzles and nobody was really a
challenge for him in the games.
 Then they found that Jimmie, when he was in church or listening to music, had a emotional and spiritual
attention that was nothing like his short "falling apart after it was done" game attention. This was his answer.
 Also, if Jimmie was taken back to his house it was like a "time-capsule" of his pre-amnesia days he would feel
instantly at home, anything that was changed seemed a surprise and he could even recognize all of his friends
saying that everyone was "oddly older than expected." It was horrifying when they had to bring him back to
the Home, but he forgot that he was ever at his real house within minutes.

CHAPTER 3: The Disembodied Lady

 Christina, 27 year old computer programmer, intelligent and cultivated.
 Had to have gallstones removed day before placed on microbial prophylaxis
 Lost her proprioception (muscle and joint sense), she could only coordinate herself or move her body if she
looked at the body part. Her hands would wander, she did not feel like her body was hers.
o The loss was due to sensory root damage of spinal and cranial nerves.
 Although her spinal inflammation subsided, the damage was already done so neurological recovery wasn’t
possible.
 Sense of body is given by three things: proprioception, balance organs (in ear), and vision.
o Christina learned to use her vision, visual and auditory feedback provided her a means in which to
recover, she could eventually sit, walk etc. But she would never feel the same.
o She loves open cars, because light touch is still somewhat intact, so while the wind hits her
extremities she can faintly feel that she has them.
 People who take too much pyridoxine (vitamin B6) will also show Christina’s symptoms, but unlike Christina,
all they have to do is stop taking too many vitamins.

CHAPTER 4: The Man Who Fell Out of Bed

 Patient with no name given does not feel that his own leg belongs to him, pushes himself off the bed at night to
get rid of the “foreign leg”
 Calls his leg a disgusting, hairy thing that somebody must have counterfeited.
 When asked where his leg is, he says it has disappeared, and cannot tell you.
 Another very similar account is given about a patient who had an embolus (free floating blood clot) cause left
hemiplegia (weakness, paralysis) that included a complete loss of awareness of his leg on the hemiplegic side.

CHAPTER 5: Hands
 Madeleine J, Age 60, blind and with cerebral palsy could not do anything with her hands. She found them as
useless as lumps of dough on the ends of her arms.
 All here sensory capacities were intact, but there was a profound impairment of perception.
 Madeleine, had apparently grown up not using her hands because of her condition, therefore with a little help
she was able to restore full sensation in her hands.
o At first they had to trick her into grabbing food when she was hungry, then the progress after that
was very rapid and she ended up becoming the Blind Sculptress.
 There was another similar patient named Simon K who unlike Madeleine, was not extraordinarily smart. He
was able to recover his use of his hands just as much showing that intelligence does not play a role.
 More accounts of “glove and stocking” neuropathy (numbness of hands/feet) due to diabetes also show that
use, is the primary remedy for brining back feeling in the numb hands/feet. As soon as the hands and feet are
tricked into being re-realized, they have them back again.

CHAPTER 6: Phantoms
 A phantom is a persistent image/memory of a body part that lasts months to years after its amputation.
 A sailor had an extended right finger phantom (constantly thought he would poke his own eye out when eating
etc.) for forty years until severe sensory diabetic neuropathy caused him to lose all sensation of even having
fingers and the phantom as well.
 A phantom is required for the use of artificial limbs. A patient had to wake up his phantom each morning by
slapping his leg stump so he could put on the prosthetic limb.
 Charles D. suffered from acute onset of tabes (slow deterioration of the spinal cord) that showed a sensory
delirium of rapidly fluctuating proprioceptive illusions. In other words, if he didn’t look at his feet, he felt like
he was moving to and fro on a boat.
 In conclusion, phantoms can be good for the purpose of prosthetic limbs, or they can be bad by causing
excruciating pain and other problems that come from thinking they are there.

CHAPTER 7: On the Level

 Mr. MacGregor, Age 93, alert, bright, strong, but with Parkinson’s disease.
 Would tilt to one side almost to the point of falling over and didn’t know it unless you showed him a mirror.
o His body’s ability to integrate his sense of self, balance organs and vision was knocked out by his
Parkinson’s disease.
 Came up with a great idea that would become “spirit spectacles,” a device used to show himself he was tilting
at all times using a “leveler” attached to his glasses.
 Although it was hard at first to look at the device and constantly adjust, eventually it became unconscious and
second nature like looking at the instrumental panel of a car.
 The spirit spectacles were a hit, other Parkinson’s disease patients who had the same problem soon donned
them, nice work MacGregor I’ll buy you some In N Out.

CHAPTER 8: Eyes Right

 Mrs S. an intelligent woman, Age 60, suffered a massive stroke effecting her right hemisphere and now ignores
everything on her left side.
 The whole idea of left has completely left her . . . . (haha . . read that sentence again), to the point that she
can’t even turn to the left.
 She developed a strategy so that she could eat all her food, by turning in circles to the right until the left side of
her food came into her right visual field.
o Although turning the plate would seem easier it did not work, did not feel natural because her
attention was not changed enough.
 Using a video-screen “mirror”, they tried to make her see her left side. She was able to see it, but she had no
feeling or existence for it and quickly cried out that they take it away.

CHAPTER 9: The President’s Speech

 People with auditory aphasias, can no longer understand words to a certain degree, but they develop an
immensely enhanced sense of the extra-verbal expressive elements of speech such as tone, gestures,
expressions, etc.
 Aphasics are so good at figuring out what’s going on from other elements of speech that you have to talk un-
naturally, like a robot even, to really see their deficit.
 You cannot lie to an aphasic, words are lost to them, and they are so good at picking up your expressive feeling
in your words so they can tell what you really mean.
 Regarding how the aphasics laugh at the Presidents speech in the chapter: they laugh because they can see how
incredibly false and incongruent the President was in his gestures/tone etc.
 Emily D had the opposite kind of problem, associated with disorders of the right temporal lobe known as tonal
agnosia.
 Emily could not understand the expressive parts of speech but could understand words well, she was a former
English teacher too.
 She had a hard time understanding slang, and became more and more adept at picking out improper prose.
 Not even Emily D was deceived by the President’s speech, she thought him to be brain damaged or something
because of his lack of good prose.
 So the only ones tricked by a presidents speech, is us normal people.
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PART 2 - EXCESSES

Introduction
 Classical “Jacksonian” neurology does not consider disorders of excess, you have to come a long way through
history to see an account of excess given by Luria.
 Excess disorders require neurology of function to move to neurology of action.
 Enhancements can be good but too much can end in a monstrous “hyper” state.
 Rose R. and Leonard L. at first described their excess (from restored health) as great then as too much and
awful.
 In disorders of excess there is a coming together of self and sickness (excess) to the point that you only think of
yourself as the sickness.

CHAPTER 10: Witty Ticcy Ray

 Tourette’s was first described in 1885 by Gilles de la Tourette, immediately following the publication hundreds
of cases were described, no two cases being exactly alike.
 Tourette’s was forgotten for a time, as was sleepy-sickness (encephalitis lethargica), but it was later found in
1974 that it was very common and just not diagnosed.
 TSA (Tourett’s Syndrome Association) was formed and from 50 members it went to thousands seven years
later.
 TSA was remarkably successful, it was the first time patients led the way to understanding and becoming
active agents of their own cure.
 Tourette’s is caused by problems in the old brain: thalamus, hypothalamus, limbic system, amygdala.
o An excess of excitatory neurotransmitter, mainly dopamine.
o Tourette’s patients therefore need a dopamine antagonist, haloperidol, or Haldol.
o Note that sleepy-sickness patients had the opposite effects of Tourett’s and are therefore treated
with dopamine (given in the precursor form L-Dopa)
 Ray, 24 years old, since 4 years old has had a severe case of Tourette’s syndrome. But because he is smart,
strong etc. he was able to school but has trouble holding a job.
 Ray is a remarkable musician (jazz drummer), this is an important survival tool for many Touretters because
while engrossed in art or play they are essentially healthy and free from crude drives and impulsions (this
effect can also be seen in Parkinson’s patients)
 Ray was also an amazing ping pong player because of his sudden, random shots.
 Dr. Sacks put Ray on Haldol, it mistimed his movements, and slowed his tics. Ray had been thrown from
Tourettism to a type of Parkinsonism.
 Ray was upset, and he also said that he didn’t want to get rid of the tics anyway because he couldn’t imagine
life without it (this is what the introduction was talking about when it said that the patient thinks of themselves
only in terms of the sickness).
 Dr. Sacks remembered that many of the sleepy-sickness patients that were helped by L-Dopa, were helped
because they liked the life they had afterward.
 o Therefore, Dr. Sacks, despite much lack of faith by Ray, spent the next three months showing the
benefits of not having Tourette’s.
o The next time Ray was put on Haldol, he found himself tic-free and things were fine, he remained
this way for 9 years.
 But the nine years were not exciting, he was less sharp, less quick, an average musician, an average ping pong
player, so he decided to be on Haldol during the week for his job and be off it during the weekend.

CHAPTER 11: Cupid’s Disease

 Natasha K. bright women, Age 90, felt a change soon after Age 88 where she suddenly felt extremely well,
flirty, excited. There was almost too much euphoria.
 Natasha contracted syphilis in a brothel 70 years ago, there was an immense latent period, and now she had
neurosyphilis.
 She wanted to be treated to stop her change from getting worse but she did not want to cure it, so they gave her
penicillin to kill the spirochetes (bacteria causing the problem), but it did nothing to reverse the cerebral
changes that had taken place.
o So in effect, Mrs. Natasha K. got what she wanted.
 Another patient suffering from an excited stage of neurosyphilis was Miguel O.
 He was so excited that when asked to copy a square with a circle inside with an x inside, he drew a large open
carton explaining how it was so much better this way.
 The second time he was asked to draw the figure on another day he drew a boy with a kite.
 After they put him on Haldol to quiet him while awaiting his spinal fluid test results, he took the test a third
time; this time he copied the figure correctly (making it a little smaller which is a common result of Haldol
called micrographia).
o He of course was very dull on Haldol, so he could only keep his imagination and inner life with
the disease, it does not specify what happened to him.

CHAPTER 12: A Matter of Identity

 Mr. Thompson, remembered nothing more than a few seconds, was continually disoriented and would make all
sorts of confabulations and fictions to fill his word with “sense.”
o To him, his fictions and confabulations were his factual and stable world.
 Mr. Thompson literally had to make himself, his world, all the people around him up every moment. It seemed
like nothing mattered, everything was said with the same “confabulation delirium,” even when he spoke the
truth like when he recognized his brother.
 Unlike Jimmie G, who was able to become normal again in his past, with his brother, Mr. Thompson was not.
After correctly identifying his brother he would instantly treat his brother like other people, as unreal, making
things up etc.
 Also unlike Jimmie G, Mr. Thompson continued his confabulations even in the spiritual atmosphere of church.
 Mr. Thompson had what Luria described as the ultimate pathology, his ultimate capacity for feeling was gone,
he will never know of his problem either.
 The only time there is some relaxation to his delirium is when he is in a quiet garden by himself.

CHAPTER 13: Yes, Father-Sister

 Mrs. B, a former research chemist presented with a rapid personality change to become funny and very
superficial not caring about anything at all.
 She had a huge carcinoma of the orbitofrontal aspects of both frontal lobes.
 Everything meant nothing to her, she was somehow de-souled as a person.
 This sort of incredible indifference was not uncommon, it was described as Witzelsucht (“joking disease”) by a
German neurologist.
 In all accounts of “joking disease” the world is taken apart and reduced to anarchy, nothing matters anymore.

CHAPTER 14: The Possessed

 Super-Tourette’s is rare, Dr. Sacks once saw an old woman who would frantically caricature the features of
forty or fifty passers-by within two minutes, each one being only a few seconds or less.
 The old woman could only escape her plight by going down an alleyway where she proceeded to “empty out”
her twitches of all the people, all at once.
 Unlike Touretter’s, the Korsakovian never knows of their plight. There is a pressure upon the soul of the
Touretter, will it take them over and posses them or can they stay whole and sovereign.
 Hume beloved that personal identify is fiction, this is not the case because a human being owns his
perceptions. A super-Touretter, however, does not own his own perceptions and therefore they are a
“Humean” (a person by Hume’s definition).
 For most super-Touretters, they are faced from childhood with a battle to become a real person, and in most
cases because of the power of survival they are able to succeed.

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PART 3 - TRANSPORTS

Introduction
 We have two universes of discourse: the physical dealing with formal structure, and the phenomenal which
constitutes a “world.”
 In the first half of this book we described pathological excesses or deficits. In this third section we will focus
on reminiscence, altered perception, imagination, dreaming.
 These “transports” are often overlooked because the personal sense and narrative of each one does not look
like a symptom that needs to be corrected.
 The theme of the following section is the power of imagery and memory to transport a person to “another
place, time, memory” as a result of abnormal stimulation of the temporal lobes and limbic system.

CHAPTER 15: Reminiscence

 Mrs O’C. Age 88, in good health, somewhat deaf, suddenly dreamt of her childhood in Ireland one night.
When she woke the music was still going and would not go away.
 EEG showed that her temporal lobes were involved, and indeed she had a thrombosis in part of her right-
temporal lobe.
 The songs eventually subsided, but for Mrs. O’C. they were a blessing, for the first five years of her life she did
not remember her mother, Ireland, or her home(she was orphaned). Her seizures had opened up closed doors
and gave her a sense of completeness.
 Mrs O’M, A similar case, woman in her eighties, somewhat deaf, also heard music but she didn’t mention it to
anyone for four years until she found that someone in the same Home had it (Mrs. O’C).
 Mrs. O’M had a commonplace inner-ear deafness but a peculiar amusia, which is a lack of perception and
discrimination of tones. This correlates with impaired function in her auditory lobes (temporal lobes), also
shown on her EEG.
 Unlike Mrs. O’C, the songs of Mrs. O’M had no special meaning and were simply a nuisance, when she got rid
of them with anticonvulsants she was very happy and did not miss them at all.
 Dr. Sacks was reminded of Penfield who was able to locate the origin of these temporal areas and evoke the
“elaborate mental state” through electrical stimulation. In all cases there remains the normal consciousness
during the “quasiparasitical state.” This was in fact the case with Mrs. O’C, and Mrs. O’M who knew where
they were and that these songs were not a reality but instead coming from their head.
 Penfield also showed that these “evoked states” are always memories and not fantasies, as was the case again
with Mr. O’C, and Mrs. O’M.
 Penfield also said that the selection of songs, memory etc. was random and did not have to have a specific
meaning.
 Dr. Sacks goes on to explain that although the preliminary form may be computational, the final form of
cerebral representation must allow for “art,” therefore, in order to assist brain damaged patients we should use
a “systematic” therapy and an “art” therapy.
CHAPTER 16: Incontinent Nostalgia
 The theme of the chapter is forced reminiscence, a good example of which is a 63 year old woman who had
progressive postencephalitic Parkinsonism since Age 18.
 Treatment with L-Dopa, all of a sudden brought about excitement and increased libido, bringing up thoughts
she had not had for more than 40 years.
 Penfield and Perot have been able to evoke stereotyped recalls by stimulating epileptogenic points in the
cortex.
 Everybody may have an almost infinite number of dormant memory traces which can be reactivated, especially
in conditions of overwhelming excitement.
o Forced reminiscence seems to be due primarily to excitation as opposed to nostalgic reminiscence
which is more like a release of inhibited memories or feelings that were repressed.

CHAPTER 17: Passage to India

 Bhagawhandi P., Indian girl of 19 had a malignant brain tumor that presented at Age 7 and was “taken care of”
giving her a complete return of function and normal life.
 Age 18 the tumor recurred, more invasive and malignant, no longer removable. A decompression was
performed to allow its expansion.
 The tumor inched to her temporal lobes and her seizures became more frequent and stranger.
o She was also put on steroids to prevent cerebral edema
 Original seizures were grand mal seizures, now she was having frequent temporal-lobe seizures.
 She began to have a dreaminess that went back to her childhood in India, they were pleasant and she enjoyed
them.
o This result was unlike the common induced temporal lobe seizures of Penfield which caused the
forthcoming of static things that repeated like songs.
o This result was also unlike steroid psychosis (which was a possibility since she was on so many
steroids) that usually presented as excited and disorganized – she was calm and peaceful.
 They weren’t dreams or fantasies, but instead, they were memories. She still knew and responded immediately
to reality but she seemed always to be in another world.
 Another week passed and she no longer responded to external stimuli, then three days later she passed away,
probably completing her passage to India.

CHAPTER 18: The Dog Beneath the Skin

 Stephen D. Age 22, medical student, used PCP, cocaine, amphetamines. And one night had a vivid dream
where the whole world was full of smells.
 This of course continued when he awoke: he could distinguish everything by its smell, his visual perception
was even enhanced as he could now do the most accurate anatomical drawings.
 Suddenly after three weeks his amazing sense of smell ceased, happy to be back but regretful of the world he
used to have.
 16 years passed and with no recurrences. Dr. Stephen. D is as normal as ever, every once in awhile he
mentions that it would be great to experience his “dog days” again.
 Dr. Stephen D’s state was probably an amphetamine-induced dopaminergic excitation causing a hyperosmia.
 Dr. Sacks also met a man who had sustained a head injury and loss his sense of smell from olfactory tract
damage.
 The man never thought anything of his sense of smell, until he lost it and everything seemed radically poorer.
 One day he thought he smelled his coffee again, and his pipe, but tests showed there was no trace of recovery
suggesting the development of greatly enhanced olfactory imagery which he was able to evoke, unconsciously,
this “power” got stronger for him.
o This “power” is similar to the compensation of the blind and deaf.

CHAPTER 19: Murder

 Donald killed his daughter under the influence of PCP and no matter what they did he could not remember it.
 Spent four years in psychiatric hospital for criminally insane, thinking he was not fit for society.
 While on probation, he was cycling, being an avid cyclist before, and swerved to dodge a car around a blind
turn only to sustain a severe head injury of both frontal lobes.
 He was in a coma for two weeks, and along with a lot of neurological problems (weakness, numbness,
seizures) he had vivid nightmares of the murder he had committed.
 It was uncontrollable, even while awake he kept seeing it again and again, he twice attempted suicide and had
to be forcibly restrained.
 Unlike most frontal lobe damaged patients, his character, judgment and general personality were conserved,
nothing of this sort (these uncontrolled reminiscences) had ever been seen before.
 EEG studies showed a deep epilepsy in the emotional parts of his temporal lobe (amygdale, limbics etc.)
o Once again, this goes against what is commonly brought about by temporal lobe seizures which is
a somewhat passive song, or scene that replays itself.
 Natural healing, time and therapy (especially the use of new to the market anticonvulsants) allowed Donald to
make an enormous recovery.
 Donald has returned to gardening that he so enjoyed while in the psychiatric hospital, he remembers the
murder still.

CHAPTER 20: Visions of Hildegard

 Hildegard of Bingen (1098-1180), a nun of exceptional intellectual and literary powers, experienced many
visions from early childhood to the end of her life.
 A careful consideration of her accounts shows that they are indisputable migrainous, showing many varieties
of visual aura.
 Hildegards visions were instrumental in directing her toward a life of holiness and mysticism.

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PART 4 – The World of the Simple

Introduction
 Contrary to what Dr. Sacks thought, Luria told him that no patients, in general, were dearer to him then the
simple or retardates.
 It is because of the qualities of the mind, other than conceptual, that are preserved or even enhanced that make
them so unique.
 The quality of mind, if it must be a single word, would have to be “concreteness,” nothing is complicated,
diluted or abstracted, their world is concrete.
 Some like Goldstein, believe that if a man loses his abstract-categorical attitude they will be subhuman. This is
not correct, the concrete is elemental (as can be seen with Dr. P who fell from the concrete to only the abstract)
 Another example is Zazetsky, who although has lost his abstract and propositional powers, he still remains a
man with moral weight and a rich imagination.
 So although classical science seems to have no room for the concrete, the concrete can in fact open doors and
constitute a portal to sensibility, imagination and depth.
 A man can be very low intellectually, unable to comprehend the world as concepts, yet fully able and indeed
gifted in understanding the world as concreteness, as symbols.

CHAPTER 21: Rebecca

 Rebecca was nineteen when given to the clinic, could not find her way around the block, would spend hours
stuffing her hand in the wrong glove.
 She was painfully shy and withdrawn but able to have strong and fond attachments, like with her grandmother,
nature and stories.
 Though she was conceptually inept, she was at home with poetic language. And she fully understood the
chants and prayers of the Orthodox service and loved them despite gross perceptual and spatio-temporal
problems.
 So although she was intellectually cripple, she was a full and complete being spiritually, with a “splinter skill”
for speech and amazing poetic power.
 The tests performed to test Rebecca were inadequate according to Dr. Sacks, she was totally normal in the
narrative sense, she seemed to continue to deepen (or Dr. Sacks just learned more about her) until her
grandmother died.
 When her grandmother died she turned into the deepest grief but still conducted herself with great dignity.
 Her grieving process was slow, but successful with the help of her aunt, the synagogue and even dreams.
 Before her grandmothers death Rebecca had been placed into workshops, as were most like her to help develop
cognitive drives.
o It is evident that this is not the way to go, the workshops simply remind them of their deficits and
Rebecca, now after her grandmother’s death, clearly stated that she hated the workshops and they
did nothing for her.
 What Rebecca really loved was the theater and after being enrolled in a special theatre group, when she was
performing on stage you could not even guess that she was mentally defective.
 Dr. Sacks goes to describe how music is very important when dealing with the retarded or apraxic because
participation in musical things has nothing to do with intelligence and music has the tendency to bring out a
“normal” person.

CHAPTER 22: A Walking Grove

 Martin A., Age 61, was admitted after becoming Parkinsonian. He had limited schooling but had a significant
musical education from his father (they had a very strong bond and shared a deep love for music).
 He had an amazing musical memory, memorizing 2000 operas, Groves Dictionary of Music with its 6000
pages, etc. He even memorized all the aspects of a performance, not just the music, who was singing, the
details of the scenery etc.
 He was slow and clumsy, but he infinitely enjoyed musical events. He became part of many choirs, and forgot
all his sadness when singing.
 He was teased and left out as a child, and constantly moved from one job to another being fired all the time.
 When he was finally brought to the Home, his childish characteristics and “showing off” of his memory made
him unpopular quickly.
 Finally he was moved back to where he once sang, and was welcomed with open arms and his life dramatically
changed. The real person reappeared, a dignified, decent man who was respected and valued by others.
 Just like Rebecca, if you saw Martin sing, there was a transformation to someone with no problems
whatsoever.

CHAPTER 23: The Twins

 John and Michael were twins, idiot savants, Aged 26 years, who could remarkably give the exact day of the
week of any particular day anytime in the future, and remember “documentary” memories to the tiniest details,
as well as long numbers etc.
 They can’t do simple addition and subtraction but they were able to come up with 12 digit prime numbers,
count a box of matches that fell on the ground in seconds, etc
 If they are asked to recall an event from their past, they can recall any day in vivid detail and just like when
they tell you a calendar day, their eyes roll up as if they are viewing a landscape in which they “see” all these
details. (This is also how they describe it, they say they just “see” it).
 Random numbers give them no pleasure, it is clear that they must have “sense” in their numbers.
o Prime Numbers were significant to them, to the point of enjoyment when they sat in the corner
giving each other numbers back and forth.
o Dr. Sacks even joined in (cheating by looking at a prime number book) and they enjoyed it with
him as well, until they got to 12 digits and Dr. Sacks (and his cheating book) couldn’t handle it.
 Numbers for them, were wholly fraught with significance – their only friends in an isolated autistic world.
 Their serenity was broken when they were separated “for their own good” so that they could become a part of
society.
o They were able to come into society for the most part, menial jobs, live in halfway houses, ride the
bus if directed etc.
o But they also seemed to have lost their strange numerical power, which was their chief joy.
CHAPTER 24: Autist Artist
 Jose, Age 21, violent seizures and said to be hopelessly retarded. Dr. Sacks was brought to him because of
intense seizures, Dr. Sacks prescribed new anticonvulsants and was not called upon again.
 But while he was there, he had asked Jose to draw his watch, and he did with remarkable fidelity.
 Dr. Sacks was so interested with Jose that he arranged another meeting and had him draw a lake with two
people in a canoe. Once again he copied the picture with amazing swiftness and accuracy, while at the same
time with a power of imagination. It was not a canoe, but it was Jose’s canoe.
 Jose did the same when asked to copy a fish, the fish he made looked more like a real fish with more character.
 Most idiot savants are talked about as having a “splinter skill”, rather than a creative ability.
 Jose had probably suffered an encephalitis of sorts when at the Age of 8 he had a severe onset of brain-
damaging seizures, with severe damage to temporal lobes (as shown by EEG).
 After the seizures, Jose had also become mute, which may be a verbal auditory agnosia caused by the temporal
lobe damage.
 At the age of 9 he dropped out of school into seclusion with his family, no anticonvulsants seemed to be able to
treat him.
 It was not until many years later that a sudden, frightening outburst of violence caused him to be taken to a real
hospital and powerful new drugs released him from his seizures for the first time.
o In the hospital he also found professional concerned people that he had not encountered before
that actually cared for him and his problem.
o But with the new environment came new pressures to interact and he would then go back to his
primitive rocking movements.
 The third time Dr. Sacks visited Jose he asked him to draw the fish he remembered, this time Jose added
another fish and made a whole scene smiling to himself. When asked to draw a robin, he copied it but made
the scenery spring instead of winter and he even began “speaking” unintellible utterances out of excitement.
 Later, Jose was moved to a quieter ward where he drew Dr. Sacks a dandelion and seems to have developed a
quick eye for plant forms and colors.
 Jose, like most autistics, has no mind for the abstract or the conceptual but instead has a real passion and power
for the particular, the concrete.
 “No man is an island, entire of itself,” except an autistic who is seldom open to influence and usually must live
in absolute isolation.