Sinopsis
I grew up in a household full of doctors and medical talk—my
father and older brothers were general practitioners, and my mother was a
surgeon. A lot of the dinner-table conversation was inevitably about medicine,
but the talk was never just about “cases.” A patient might present as a case of
this or that, but in my parents’ conversation, cases became biographies, stories
of people’s lives as they responded to illness or injury, stress or misfortune.
Perhaps it was inevitable that I myself became both a physician and a
storyteller.
When The Man Who Mistook His Wife for a Hat was
published in 1985, it was given a very pleasant review by an eminent academic
neurologist. The cases, he wrote, were fascinating, but he had one reservation:
he thought I was being disingenuous in presenting patients as if I had come to
them with no preconceptions, with little background knowledge of their
conditions. Did I really read up on the scientific literature only after seeing
a patient with a particular condition? Surely, he thought, I had started with a
neurological theme in mind and simply sought out patients who exemplified
it.
But I am not an academic neurologist, and the truth
is that most practicing physicians have, apart from their broad medical
education, little in-depth knowledge of many conditions, especially those which
are considered rare, and thus not worthy of much time in medical school. When a
patient presents himself with such a condition, we must do some research and,
especially, go back to original descriptions. Typically, then, my case histories
start with an encounter, a letter, a knock on the door—it is the patients’
description of their experience that stimulates the more general
exploration.
As a general neurologist working mostly in old-age homes, I have
seen thousands of patients over the past decades. All of them have taught me
something, and I enjoy seeing them—in some cases, we have been seeing each other
regularly, as doctor and patient, for twenty years or more. In my clinical
notes, I do my best to record what is happening with them and to reflect on
their experiences. Occasionally, with the patient’s permission, my notes evolve
into essays.
After I began publishing case histories, starting with
Migraine in 1970, I began receiving letters from people seeking to
understand or comment on their own neurological experiences, and such
correspondence has become, in a way, an extension of my practice. Thus some of
the people I describe in this book are patients; others are people who have
written to me after reading one of my case histories. I am grateful to all of
them for agreeing to share their experiences, for such experiences enlarge the
imagination and show us what is often concealed in health: the complex workings
of the brain and its astounding ability to adapt and overcome disability—to say
nothing of the courage and strength that individuals can show, and
the inner resources they can bring to bear, in the face of neurological
challenges that are almost impossible for the rest of us to imagine.
Many of my colleagues, past and present, have generously shared
their time and expertise to discuss the ideas in this book or to comment on its
various drafts. To all of them (and the many whom I have omitted here) I am most
grateful, especially to Paul Bach-y-Rita, Jerome Bruner, Liam Burke, John Cisne,
Jennifer and John Clay, Bevil Conway, Antonio and Hanna Damasio, Orrin Devinsky,
Dominic ffytche, Elkhonon Goldberg, Jane Goodall, Temple Grandin, Richard
Gregory, Charles Gross, Bill Hayes, Simon Hayhoe, David Hubel, Ellen Isler at
the Jewish Braille Institute, Narinder Kapur, Christof Koch, Margaret
Livingstone, Ved Mehta, Ken Nakayama, Görel Kristina Näslund, Alvaro
Pascual-Leone, Dale Purves, V. S. Ramachandran, Paul Romano, Israel Rosenfield,
Theresa Ruggiero, Leonard Shengold, Shinsuke Shimojo, Ralph Siegel, Connie
Tomaino, Bob Wasserman, and Jeannette Wilkens.
I could not have completed this book without the moral and
financial support of a number of institutions and individuals, and I am
enormously indebted to them, above all to Susie and David Sainsbury, Columbia
University, The New York Review of Books, The New Yorker, the Wylie
Agency, the MacDowell Colony, Blue Mountain Center, and the Alfred P. Sloan
Foundation. I am grateful, too, to the many people at Alfred A. Knopf, Picador
UK, Vintage Books, and my other publishers around the world.
Several correspondents have contributed ideas or descriptions to this book, including Joseph Bennish, Joan C., Larry
Eickstaedt, Anne F., Stephen Fox, J. T. Fraser, and Alexandra Lynch.
I am grateful to John Bennet at The New Yorker and Dan
Frank at Knopf, superb editors who have improved this book in many ways; and to
Allen Furbeck for his help with the illustrations. Hailey Wojcik typed many of
the drafts and contributed research and virtually every other type of
assistance, to say nothing of deciphering and transcribing the almost 90,000
words of my “melanoma journals.” Kate Edgar has, for the past twenty-five years,
filled a unique role as collaborator, friend, editor, organizer, and much else.
She has incited me, as always, to think and write, to see from different
perspectives, but always to return to the center.
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