Sacks begins by sharing his encounter with a music teacher named Dr. P. Despite being a talented musician, Dr. P. faces a peculiar problem - he cannot recognize faces, including those of his own family members and himself in photographs. Sacks meets with Dr. P. and observes his perception or lack thereof when presented with various objects. For instance, when asked to put on his shoe, Dr. P. looks at his foot and thinks it's his shoe, and when he sees his shoe, he believes it's his foot. Similarly, he can describe a rose in abstract terms but cannot recognize it until he smells it. When describing entering a town square, Dr. P. only recallsthe buildings on his left side, ignoring those on his right.
Upon visiting Dr. P.'s home, Sacks notices a collection of paintings that Dr. P. created over time. Initially, the paintings are detailed and clear, but as they progress, they become more abstract to the point where the shapes are unrecognizable. Dr. P. has a tendency to see things abstractly but struggles to perceive how visual stimuli fit together and convey meaning. He can recognize individual parts of faces and cartoon faces, but he cannot recognize faces from television or interpret emotional expressions. However, he can easily identify people based on their unique movements, such as their gait and posture. Dr. P.'s wife reveals that he navigates daily tasks, like getting dressed or bathing, by singing songs that help him maintain a rhythmic pattern. If he stops singing, he becomes disoriented.
Despite his unusual behavior, Dr. P. does not seem troubled by it or even recognize it as peculiar. He is unaware of his condition and only mentions that "other people" have commented on his eyes. Sacks clarifies that the issue lies not with his eyes but with his brain's ability to
process visual information. Dr. P. can perceive visual data but struggles to integrate it into a cohesive whole picture.
At the end of the chapter, Sacks encourages Dr. P. to rely on music as a way to assist him with his visual agnosia. Although Sacks never sees Dr. P. again, he hears that Dr. P. was able to continue teaching until the end of his life.
In the postscript, Sacks mentions another case of visual agnosia called "The Defect of Function in Visual Agnosia" recorded by Donald Macrae and Elli Trolle in the 1956 edition of Brain. Additionally, he references Dr. Andrew Kertesz's research from 1979, titled "Visual Agnosia: The Dual Deficit of Perception and Recognition," as a source for further information on visual agnosia.
Sacks recounts the story of his patient, Jimmie G., a 79-year-old man who believes he is 19 years old and that the current year is 1945. When shown a mirror, Jimmie becomes deeply confused and agitated. However, his distress quickly dissipates once the mirror is removed. Sacks observes that Jimmie, despite being bright and intelligent, is unable to form new memories. Jimmie's background further puzzles Sacks, as he grew up in Connecticut, joined the Navy at 19, and served until 1965. Reports indicate thatJimmie did not exhibit neurological problems until the end of his service when he began heavy drinking. It is unclear when Jimmie lost his ability to create new memories or why his memories do not extend beyond 1945.
Jimmie's condition is identified as Korsakoff's syndrome, an amnesic disorder typically associated with alcohol use and vitamin B1 deficiency. A similar case reported by A. R. Luria involves a man named Zazetsky, who also lost his ability to form new memories but was aware of his condition and actively worked to regain his capabilities. In contrast, Jimmie is largely unaware of his condition unless it is pointed out to him. Even then, his recognition is fleeting. For example, when Jimmie's brother visits, Jimmie fails to recognize him and struggles to accept that the old man in front of him is his sibling, believing that his brother should still be a young man.
Sacks ponders the idea of a person being complete without their
memories. Jimmie lives a fragmented life, unable to form new connections. Sacks discusses his conversation with nuns at Jimmie's residence, where he inquires about whether they believe Jimmie possesses a "soul." The nuns suggest observing Jimmie in the chapel, where Sacks witnesses him engaged in deep concentration during prayer. Although Sacks never unravels the mystery of Jimmie's retrograde amnesia, he assists him in developing a greater emotional awareness and connection with the world, which he refers to as Jimmie's "soul," through engagement in artistic activities, gardening, and prayer.
In the postscript, Sacks mentions another patient, Stephen R., who also had Korsakoff's syndrome. Stephen's memory loss began in 1980, and he could not form new memories after 1978. While Stephen seemed fine in his familiar home environment, he became confused when exposed to new buildings or encountered friends who had aged. Eventually, Stephen's wife brought him to a psychiatric hospital, where he lived in a state of fear and confusion. Sacks reflects on the varied degrees of retrograde amnesia experienced by individuals with Korsakoff's syndrome, raising questions about what society can do to support those affected by this condition.
Sacks introduces Christina, a 27-year-old athletic and intelligent woman who enjoys horseback riding and sports. She requires routine surgery for gallstones and takes antibiotics before the procedure. However, after having a nightmare about losing sensation in her body, Christina wakes up to find her dream has become a reality. She developssevere sensory polyneuropathies, which disrupt her sense of proprioception - the body's awareness of itself through movement, action, and location. Essentially, Christina becomes "disembodied" from her own body.
Proprioception, also known as kinesthesia, enables a person to perform tasks like reaching for a glass of water with ease. These movements rely on the coordination of proprioception, vision, and the vestibular system(the balance organs). If one of these systems fails, the others can compensate. Realizing that her body can no longer sense itself, Christina understands that she must rely on her other senses, particularly her eyes and ears, to navigate the world since her body no longer
comprehends how to do so.
Three months after her initial meeting with Sacks, Christina becomes more adjusted to her condition. She regains the ability to sit up straight, speak, walk, and live a relatively normal life. However, her movements appear affected and unusual, and she speaks as if she were on stage(speech also relies on proprioception). Unlike other disabilities, people may not immediately recognize that Christina experiences nerve damage, making movement and speech challenging for her.
In the postscript, Sacks shares that he later learned about other individuals who lost proprioception after taking pyridoxine(B6) as part of a weight loss program. Fortunately, these individuals regained their faculties after ceasing to take the supplements.
A man visits a clinic with a belief that his leg is not real. While at the clinic, he falls out of bed during the night, displaying a mix of agitation, amusement, and confusion. He is convinced that the leg in his bed belongs to someone else and theorizes that the nurses, on New Year's Eve, must have taken a severed leg from the morgue and placed it in his bed as a prank. The man attempts to push his own leg off the bed and follows it to the floor. Even when fully awake and in the light, he cannot recognize the leg as his own or explain the whereabouts of his real leg. Sacks inquires about his real leg, but the man is unable to provide an answer.
In the postscript, Sacks receives a letter from Dr. Michael Kremer, a prominent neurologist, sharing a similar case of a patient experiencing a loss of awareness, along with hemiplegic limbs(one-sided paralysis).
Sacks tells the story of Madeline J., a 60-year-old woman with cerebral palsy and congenital blindness.Madeline is intelligent and knowledgeable, but she cannot read braille due to her inability to use her hands. Sacks ponders whether her hands are nonfunctional or if she has a "learned agnosia" stemming from a lack of opportunities to use her hands. To test this, Sacks instructs the nurses to place Madeline's food
just out of reach, forcing her to stretch and grasp for it. This exercise quickly improves her ability to reach and grasp objects. Following this training, Madeline discovers a passion for sculpting and finds joy in this independent creative activity.
In the postscript, Sacks shares another story of a patient named Simon K., who also has cerebral palsy and a vision condition. Simon rarely used his hands despite their strength and capability. However, after Sacks teaches him how to use his hands, Simon becomes capable of carpentry and crafting simple toys.
Sacks discusses phantom limbs, referencing the work of American neurologist Silas Weir Mitchell, who studied soldiers with amputations during the Civil War. Mitchell coined the term "sensory ghosts" to describe the experience of having a phantom limb, which can be painless or painful.
Sacks shares the story of a sailor who accidentally cut off his finger. Despite the loss, the sailor continues to feel the presence of the finger for 40 years, fearing that it might poke him in the eye when he goes to scratch his nose. However, the sailor mysteriously loses the sensation of the phantom finger along with the feeling in his real fingers.
Sacks mentions Dr. Michael Kremer, noting that a phantom limb is crucial for a person to gain control over a prosthetic limb. He describes how one patient "wakes up" his phantom limb in the morning by slapping the stump of his leg until he can feel the phantom sensation. This mental memory of the phantom limb becomes incorporated into the artificial limb, making it feel like a natural part of his body.
Sacks also shares his personal experience of temporarily losing proprioception in his legs, documented in his autobiographical essay, "A Leg to Stand On." Although he could use his legs, he couldn't feel them, leading to a sense of instability unless he looked down at his limbs. He raises the question of whether phantoms experienced by individuals are "real" or imaginary, emphasizing the importance of considering a patient's lived experience to understand their sensations.
In the postscript, Sacks mentions that many patientsexperience phantom pain, which can persist even after amputation. He provides an
example of a patient who reported pain due to an ingrown toenail that existed prior to the amputation, highlighting that the pain is real and not merely "imaginary."
Sacks introduces Mr. MacGregor, a man he met nine years ago who was told he walked with a tilt. When asked to walk across the room, Mr. MacGregor starts out straight but quickly begins tilting without sensing the tilt himself. Sacks films the man's movements, and when confronted with the evidence, Mr. MacGregor starts to understand his problem. Sacks explains that the inner ear plays a role in maintaining balance and compares Mr. MacGregor's issue to not having a "level" in his inner ear.
By asking Mr. MacGregor to walk while looking into a mirror, Sacks finds that he can maintain his balance. Sacks references chapter 3, where he explains the three mechanisms involved in walking: proprioception, the vestibular system(organs of balance), and vision. Mr. MacGregor can rely on sight to compensate for his inner ear deficit when looking in a mirror, but it is acknowledged that he cannot constantly rely on a mirror for balance.
On his own, Mr. MacGregor devises a solution by attaching a level to the inside of his glasses, which helps him maintain balance while walking. This innovation proves to be beneficial, with several other patients at the clinic adopting the idea and having similar levels made for themselves.
Sacks tells the story of Mrs. S., who suffered a stroke and lost awareness of the left side of her perception. Despite being a bright woman, Mrs. S. could only see and eat from the right side of a plate and applied makeup only to half of her face. She was aware that something was wrong but couldn't see what she was missing. To compensate, she would rotate herself in a full circle to access the left side of anything. If she wanted to eat a full meal, she would start from the right side and then turn herself around to see the remaining portion of the plate.
Sacks conducts an experiment by showing Mrs. S. a video of herself,
using the video as a mirror. Mrs. S. is astonished to see her left side once again, although she still cannot feel it. This realization disturbs her, and she asks to have the videoremoved. Sacks suggests that the video could potentially help others facing the same problem if they became accustomed to it.
In the postscript, Sacks mentions a book titled "Principles of Behavioral Neurology" edited by M. Marsel Mesulam, which provides a more in-depth exploration of this subject. Although Sacks couldn't reference the book during his writing, he directs readers to it now. Mesulam explains the concept of "neglect," where patients like Mrs. S. act as if their left hemisphere does not exist or is of no consequence.
Sacks recalls an incident in the aphasia ward where he hears patients laughing at the speech of an unnamed actor-turned-politician, who is revealed to be Ronald Reagan. Aphasia is a condition characterized by an inability to understand or express speech, resulting from damage to the left hemisphere of the brain. Individuals with aphasia may struggle with words but are highly sensitive to tone and body language. Their interpretive skills can develop to the point that their friends and relatives may not even realize they have the condition. Clinicians can confirm the presence of aphasia by testing patients using a toneless, mechanical voice, such as that of a computer. Only without contextual clues can clinicians determine if individuals with aphasia comprehend the words alone. Patients with aphasia are sometimes likened to dogs because they can read body language without intellectually understanding words.
Henry Head's book on aphasia, "Aphasia and Kindred Disorders of Speech," published in 1926, emphasizes that it is difficult to deceive a person with aphasia, as they can pick up on subtle cues and detect dishonesty. The aphasia patients were laughing at the president's speech because they could perceive the false tones in his voice with heightened sensitivity, making the phoniness appear grotesque to them.
On the other hand, some individuals experience tonal agnosia, which affects the right hemisphere of the brain. People with tonal agnosia may understand words but miss the tone of voice or emotional cues. One such patient, Emily D., was in the ward. Emily, a former English teacher and somewhat of a poet, comments on the president's speech, pointing
out his poor grammar and suggesting that he may be impaired or hiding something from the audience. Unlike the aphasia patients, Emily laughs at the president's words rather than his tonal cues.
Sacks concludes with a paradox, noting that "normals" have a willingness to be deceived and would not make thesame observations as Emily and the other patients. The patients, due to their conditions, have lost their ability to be deceived by cunning words and tones.
Sacks reflects on the historical focus of neurology on studying patients with deficits, those lacking certain functionalities. However, he argues that conditions of excess can be just as informative. Part 2 explores these conditions of excessive functionality, where individuals exhibit unusual or atypical actions and behaviors. While these conditions can result in increased creativity, they can also have negative consequences. Sacks describes the paradox of illnesses that initially present as feelings of wellness and health but later reveal their malignant potentials. He provides examples such as George Eliot, who felt "dangerously well" before experiencing a migraine, and his own patient Rose R., who experienced the joy of restored health but understood that it wouldn't last. Sacks explains that individuals with excess conditions may have a heightened sense of knowing before descending into heightened paranoia. In the upcoming chapters, Sacks shares stories of patients who exemplify these conditions of excess.
Sacks discusses Gilles de la Tourette's publication on Tourette's Syndrome, a condition characterized by an excess of nervous energy resulting in uncontrolled tics and involuntary movements. In the 1900s, scientific interest in Tourette's declined, with researchers dismissing the tics as psychological or imaginary. However, in the 1970s, the Tourette's Syndrome Association(TSA) helped increase understanding of the condition. Sacks introduces a patient called Ray, who has experienced Tourette's since childhood. Ray self-diagnosed his condition and was unaware of treatment options like Haldol, a drug used to counteract excess dopamine in the brain. Without treatment, Ray couldn't maintain his job as a jazz drum player due to his tics. Sacks prescribes Haldol, but it slows Ray down and affects his timing, causing him to injure himself. Sacks decides to halt the medication and work with Ray to prepare for a
life without Tourette's. After three months, Sacks reintroduces Haldol, and this time, Ray responds well and loses his tics. However, Ray feels a loss of energy, quick-wittedness, and creativity. He decides to suspend Haldol use on weekends but finds that neither state, on or off the medication, allows him to feel truly free. Sacks reflects on Ray's resilience through his illness.
Natasha, an 89-year-old woman, seeks Sacks's help regarding her unusual behavior. Despite her age, she feelsfrisky and has become flirtatious, causing concern among her friends. Natasha self-diagnoses her condition as "Cupid's disease," or syphilis. She worked in a brothel in the past and received treatment for syphilis before penicillin was available. Tests reveal that Natasha has neurosyphilis, an infection of the brain and spinal cord caused by syphilis bacteria. This condition manifests as disinhibitions, which are responsible for her youthful feelings. While Natasha enjoys her current state, she wants to stabilize the deterioration caused by the disease without completely suppressing her disinhibited behavior. Doctors administer penicillin to treat the syphilis but do not counteract her personality changes.
In the postscript, Sacks describes encountering a similar dilemma in Miguel O., a farmhand in Puerto Rico with neurosyphilis and speech and hearing disabilities. Miguel shows excessive energy and excitement, but when treated with Haldol, he loses the joy in his creative drawing. Miguel asks Sacks if he will always feel "dead," and Sacks explains that this reaction is common. Patients can be treated with L-Dopa to regain energy, imagination, and a sense of aliveness, but they may subsequently lose those elevated feelings. Sacks relates Miguel's case to the paradox of illness and wellness, noting how inner life and imagination may remain dormant until released or awakened by intoxication or disease. He observes the confining or cathartic nature of elevated states.
Sacks meets William Thompson, who initially recognizes Sacks as an old friend named "Tom," but then changes his mind and calls him
"Chaim." He further declares that Sacks is a mechanic and later identifies him as a doctor upon seeing the stethoscope. Mr. Thompson appears disoriented and has extreme Korsakoff's syndrome, similar to Jimmie G. from chapter 2. However, unlike Jimmie, Mr. Thompson compensates for his memory loss by making up stories, a condition Sacks refers to as "mythomania." Mr. Thompson lacks emotional affect and fails to understand that something is missing in his life. Sacks compares him to Jimmie G. and Luria's patient, Zazetsky, noting that Mr. Thompson seems to have lost his "soul" and deeper emotional capacity. Despite trying spiritual and creative interventions, the sisters working with Sacks do not succeed in helping Mr. Thompson. However, Sacks observes that Mr. Thompson finds a sense of peace in the absence of people and in the presence of plants, temporarily restoring his "sense of being."
Mrs. B. undergoes a drastic personality change,becoming superficial, witty, and unable to take anything seriously. She has a cerebral tumor. When Sacks meets her, she refers to him as "father," then "sister," and finally "doctor." She associates his beard with a priest, his white uniform with the sisters, and his stethoscope with a doctor. Sacks tests whether she understands differences between pairs, but Mrs. B. insists that "differences" are "meaningless" despite claiming to comprehend them. Sacks is skeptical and wonders if she is hiding pain behind her nonchalant demeanor. He describes her as "de-souled" and references Luria's concept of "equalization." The condition is referred to as Witzelsucht or "joking disease" in German, and John Hughlings Jackson sees it as a symptom of nervous "dissolution." Sacks notes that he has observed similar behaviors in various patients across different conditions and expresses horror at the loss of self associated with such extreme states of "unfathomable silliness."
In the postscript, Sacks mentions that these conditions leave patients unable to provide firsthand accounts of their experiences, comparing it to Jorge Luis Borges's story "Funes the Memorious" and Alexander Pope's The Duncaid, which depict the overwhelming nature of memory and extreme states of silliness leading to the death of the self.
Sacks discusses more severe forms of Tourette's syndrome, where the condition disintegrates a person's personality, leading to what he calls "super-Tourette's." He observes "Touretters" on the streets of New York, finding it a better place to understand Tourette's than in a clinical setting. The unpredictable environment allows him to observe how Touretters interact with various stimuli. He refers to this as "street-neurology."
While on the streets of New York, Sacks encounters a gray-haired woman in her sixties who exhibits convulsive movements. She caricatures and mirrors the movements of 50 passersby in just two minutes, shocking those who see her imitating their actions. Sacks describes how she becomes everybody and yet nobody, losing a sense of identity. Eventually, she retreats into an alleyway, where she releases all the pantomimed gestures in a frenzied burst. Sacks believes that super-Touretters are driven to delirium, lacking understanding and control over their condition. They struggle to find a center or sense of identity, facing barriers to individuation.
Sacks compares the spectacle of the woman to an imagined case of "super-Korsakov's" and highlights the awareness that Touretters have of their condition. Unlike those with Korsakoff's syndrome who may not be aware of their condition, Touretters perceive theirplight acutely but may be limited in their ability or willingness to do something about it. Despite these barriers, Sacks emphasizes the lifelong fight of individuals with Tourette's to maintain their sense of self. He admires their will to survive, which he believes is stronger than both their impulses and the disease itself.
Sacks begins by reflecting on the patients he has encountered in the previous two parts of the book, who had either deficits or excesses of functionality. In Part 3, he shifts his focus to patients with unique manifestations of memory, which he refers to as "transports." These disorders involve deeply personal and sensory experiences, requiring a language beyond the scope of neuroscience alone. Sacks suggests that
the language of poetry and painting is better suited to capture the essence of these conditions and convey their intricacies.
Sacks introduces us to Christina, a young woman who experiences severe epileptic seizures that cause her to lose consciousness and enter a state of complete oblivion. During these episodes, she has no awareness of herself, her surroundings, or the passage of time. She describes it as falling into an abyss or being in a void where there is nothing. The seizures are debilitating and disrupt her life, leaving her feeling disoriented and disconnected from reality.
Sacks explains that Christina's seizures are a form of temporal lobe epilepsy, which affects the temporal lobes of the brain responsible for memory and perception. The seizures cause temporary disruptions in her consciousness and memory, leading to the sense of emptiness and loss. Despite the frightening nature of her condition, Christina remains hopeful and determined to find a way to regain control over her life.
Sacks explores the phenomenon of epileptic seizures and their impact on consciousness. He describes how some individuals with epilepsy have reported profound spiritual experiences or mystical feelings during their seizures, while others experience a sense of terror and dread. He mentions the work of Russian novelist Fyodor Dostoevsky, who himself had epilepsy and wrote about the intense emotions and altered states of consciousness that accompanied his seizures.
Sacks emphasizes the complexity of epilepsy and its profound effects on a person's sense of self and identity. He reflects on the limitations of medical knowledge in fully understanding the experiences of individuals with epilepsy and acknowledges the need for further research and exploration in this field.
Postscript
Sacks concludes the chapter byexpressing his admiration for individuals like Christina, who face the challenges of epilepsy with resilience and determination. He believes that their experiences offer valuable insights into the mysteries of consciousness and the complexities of the human mind. Sacks acknowledges that there is still much to learn and discover about epilepsy and its profound impact on
the lives of those affected by it.
Cassandra is a young woman with severe epilepsy. Her seizures are so frequent and intense that they severely disrupt her life. Sacks describes how Cassandra experiences premonitions or a sense of impending doom before each seizure. These premonitions manifest as intense feelings of fear, anxiety, and a strong sense of d?j? vu. Cassandra becomes convinced that she can predict the future and that her seizures are a form of prophetic ability.
Sacks explores the concept of epilepsy as a condition that blurs the boundaries between the present, past, and future. He reflects on the historical association of epilepsy with mystical and prophetic experiences. Cassandra's seizures, with their accompanying premonitions, illustrate the complex interplay between brain function, consciousness, and the perception of time.
Sacks notes that Cassandra's experiences are subjective and deeply personal. While others may dismiss her premonitions as mere hallucinations, Sacks recognizes the profound impact they have on Cassandra's sense of self and her understanding of the world. He emphasizes the need for empathy and understanding when dealing with individuals who have unique perceptual experiences.
Postscript
Sacks concludes the chapter by contemplating the nature of consciousness and its relation to time. He acknowledges the limitations of scientific understanding in fully grasping the intricacies of subjective experiences like Cassandra's premonitions. Sacks maintains that the exploration of such experiences requires a broader perspective that encompasses both scientific inquiry and an appreciation for the individual's subjective reality.
Sacks recounts his interactions with a number of prodigious individuals who possess exceptional talents in specific domains. He introduces the reader to individuals like Nadia, an autistic artist with an extraordinary
ability to recreate intricate architectural scenes from memory, and George, a musical savant with a remarkable memory for classical compositions. Sacks explores the phenomenon of prodigious abilities and their relationship to neurological conditions.
Sacks explains that prodigious abilities often emerge in individuals who have some form of neurological impairment or disorder. These abilities are often seen as compensatory mechanisms that develop as a result of the brain's unique wiringor functioning. He emphasizes that these prodigious individuals possess an exceptional focus and dedication to their specific talents, often at the expense of other areas of functioning.
Sacks reflects on the limitations and challenges faced by prodigious individuals, such as the isolation and difficulties in navigating social interactions. He highlights the importance of providing support and understanding to help them harness their talents and integrate into society.
Postscript
Sacks concludes the chapter by acknowledging that prodigious abilities are still not fully understood by neuroscience. He considers them as glimpses into the extraordinary potential of the human brain and the mysteries that lie within its intricate workings. He emphasizes the need for further research and exploration to unravel the complexities of prodigious abilities and their underlying neurological mechanisms.
Sacks introduces the reader to the lives of the twins John and Michael, who are identical in appearance but have contrasting intellectual abilities. John is developmentally disabled and has an IQ of 50, while Michael is of average intelligence. Despite their differences, the twins have a deep and meaningful bond, communicating with each other through a unique language of their own. They share a world of concrete experiences, filled with simplicity, joy, and a rich connection to nature.
Sacks explores the concept of mental retardation and challenges the prevailing notion that individuals with intellectual disabilities are inferior or lacking. He highlights the remarkable perceptual and sensory abilities that John possesses, such as his acute hearing and sensitivity to vibrations. John's simplicity allows him to appreciate the beauty and
intricacy of everyday objects and moments in a profound way.
Sacks emphasizes the importance of acknowledging and valuing the unique abilities and perspectives of individuals with intellectual disabilities. He suggests that society can learn from them, as they possess a distinct mode of being that is not limited by abstract thinking but is grounded in the concrete and immediate experiences of life.
Sacks introduces the reader to Jonathan, an artist with autism who possesses extraordinary artistic talent. Jonathan's artworks exhibit meticulous attention to detail, precision, and a remarkable ability to capture complex scenes. Sacks explores Jonathan's creative process and the unique way in which he perceives and interprets the world around him.
Sacks reflects on the limitations and challenges faced by individuals with autism, such as difficulties in social interactions and communication. However, he also highlights the immense potential andgifts that can emerge from their unique neurology. Jonathan's artwork serves as a testament to the richness and depth of his inner world, which he expresses through his artistic creations.
Sacks emphasizes the importance of providing support and opportunities for individuals with autism to develop and showcase their talents. He believes that society should move beyond viewing autism solely as a disability and instead recognize the immense creative and intellectual capacities that can coexist with the challenges of the condition.
Postscript
Sacks emphasizing the need for a shift in perspective and a more inclusive approach to understanding and valuing individuals with intellectual disabilities. He emphasizes the importance of the romantic science, which embraces the concrete and holistic aspects of human experience, in uncovering the unique capabilities and contributions of these individuals. Sacks invites the reader to delve into the stories of the "gifted simpletons" who will be explored in the following chapters, providing a deeper understanding of their lives and the richness of their existence.
Rebecca is a 19-year-old girl referred to the clinic. She had lost her parents at a young age and was raised by her grandmother. Rebecca exhibits child-like behaviors and struggles with spatial awareness and motor functions. Despite her challenges, she forms deep attachments and possesses a love for nature and stories. Although she cannot read, her grandmother reads stories and poetry to her, and Rebecca shows a remarkable understanding of imagery and symbolism in even complex poems. She finds comfort and peace in certain rituals and exhibits a poetic sense of understanding. Rebecca's unique way of perceiving the world highlights the limitations of traditional tests that only focus on deficits. Sacks recognizes the need to embrace the concrete and narrative aspects of life, and he witnesses Rebecca's transformation when she engages with music and theater. Rebecca's story challenges the notion of intellectual disabilities defining a person's worth and highlights the importance of recognizing and nurturing individuals' unique capabilities.
Martin A., a man with delayed intellectual development due to childhood meningitis, possesses extraordinary musical abilities and an exceptional memory. He can remember entire operas after hearing them only once and has an eidetic memory for certain information. Music brings color and joy to Martin's life, allowing him to momentarily forget his limitations. Although his world outside of music is challenging and dark,his connection to music and his father's voice evoke strong emotions in him. Martin's passion for music and his involvement in a church choir provide him with a sense of dignity and respect among his peers. Sacks reflects on the intersection of intellectual disabilities and exceptional abilities, recognizing the profound intelligence and understanding that can exist in a specific area despite overall cognitive limitations.
Postscript
Sacks highlights the existence of other cases, such as Harriet G., who exhibit advanced capabilities in specific areas despite intellectual
disabilities. He acknowledges the genuine intelligence and understanding that these individuals possess within their narrow focus. Sacks refers to an article by L. K. Miller that explores the tonal structure sensitivity of a developmentally disabled musical savant. These unique cases challenge the conventional perception of "idiot savants" and reveal the complexities and depths of human intelligence.
Sacks introduces John and Michael, identical twins who are well-known for their extraordinary abilities. They have been diagnosed with multiple disorders, including autism, psychosis, and delayed intellectual development. The twins possess unique physical characteristics such as disproportionate heads and hands, high-pitched voices, arched palettes, and degenerative myopia. They have gained fame for their remarkable memory for minute visual details and their ability to determine the day of the week for any given date. The twins are featured in Steven Smith's book "The Great Mental Calculators." While other doctors have focused on the twins' testable surface traits, Sacks recognizes their complexity and delves into their abilities and experiences.
The twins possess a remarkable capacity to remember numbers, yet they struggle with basic arithmetic calculations. They are "calculators" who cannot calculate. Sacks acknowledges the mysterious but simple nature of their abilities. At the age of four, they began to unconsciously compute algorithms, allowing them to provide information about dates, including the weather and events that occurred on those days. When asked about their ability to remember, the twins simply say they "see" it.
Sacks observes a fascinating interaction between the twins, where they engage in a conversation involving six-figure numbers. He realizes they are speaking in prime numbers and joins in their game by introducing larger numbers. The twins respond with excitement, demonstrating their ability to work with increasingly complex primes, even reaching twenty-digit numbers.
Sacks reflects on numbers as iconic entities and draws parallels between numbers and music, suggesting that the twins experience numbers as tones andtreat them as "friends." They have a harmonic sensibility and perceive numbers as more than mere numerals. Sacks emphasizes that intellectual pursuits are inherently connected to the
senses and the personal.
Later, the twins are separated by doctors in an attempt to integrate them into "normal" society. Their unique means of communication is considered "unhealthy," and without their shared communion, the twins lose their numerical abilities. Sacks highlights the significance of their numerical language, which was a core part of their identities. Their loss of this ability results in a sense of disorientation and a loss of center.
Sacks draws a parallel to Nadia, a child with autism whose drawing abilities were inadvertently sacrificed in favor of language development through therapy. He questions the worth of sacrificing innate, extraordinary abilities for the sake of social acceptability, echoing the sentiments of writer Nigel Dennis.
In the postscript, Dr. Israel Rosenfield suggests that the twins' abilities may stem from cyclical pattern recognition and the ability to calculate simple algorithms. Sacks considers the idea that their abilities are connected to spatial organization and visualization of information, drawing insights from Rosenfield and mathematician Ian Stewart's work to demystify the twins' extraordinary powers.
Sacks introduces Jos?, a 21-year-old nonverbal man whom an attendant degrades as an "idiot" incapable of understanding. Sacks observes that Jos? visibly reacts to the attendant's harsh tone. To assess Jos?'s abilities, Sacks gives him a watch to draw, and although the drawing is not technically accurate, it captures the essence of the watch and includes surprising detail. Sacks then asks Jos? to draw pictures from a magazine, and again, Jos? demonstrates creativity and perception by adapting the imagery in an interpretive manner. His drawings bring out dramatic elements that the original photos lack.
At the age of eight, Jos? experienced a high fever, which led to seizures and subsequent diagnosis of autism by doctors. Sacks challenges the notion that Jos? is merely an "idiot" or autistic and speculates that he may have had encephalitis, which can result in temporal lobe damage affecting speech and language comprehension.
Jos? spent 15 years confined to his home due to his mother's fear of his seizures, which occurred daily. During this time, Jos? looked at
pictures and drew while being kept in a cellar. After a violent episode, he was brought to a state hospital where Sacks visits him. Jos? appearsin a regressed state, rocking himself in a corner. Sacks takes him to the art room and asks him to draw a fish he had previously drawn three weeks earlier. This time, the trout has human features, and Jos? adds additional elements to the scene. He then cries out after drawing a large wave. Eventually, Jos? is moved to a more supportive "home for the heart," where individuals with autism receive better care than in regular wards.
During a visit to the home, Jos? takes Sacks for a walk outdoors. Sacks notices Jos?'s recognition of different plants and his particular attraction to a dandelion, which he proceeds to draw. Sacks observes that Jos? lacks abstract thought but possesses a deep affinity for the particular and the concrete. He considers Jos? a "natural artist."
Sacks challenges the common belief that individuals with autism cannot express themselves uniquely or have a sense of humor or originality. Jos?, among others he has encountered, proves the opposite. Sacks concludes the chapter and the book by pondering Jos?'s future and the fate of people like him. He recognizes Jos?'s artistic potential, noting that with understanding and support, Jos? could provide illustrations for various organizations. However, without such opportunities, he is likely to remain overlooked.
Sacks shares that he received numerous letters from other doctors following the publication of "The Autist Artist." He acknowledges the impossibility of testing for artistic potential and emphasizes the importance of spontaneous artistic production and the need for an intimate and empathetic relationship, rather than formal training alone, for artists with autism to thrive.