The Man who Mistook his Patient for a Brain: A critical analysis of Oliver Sacks’ treatment of character in his writing
Mar 20, 2026 | 7 min read
Oliver Sacks’ rise and reputation as a writer grew from his stories of people affected by neurologic conditions. His most famous book, The Man who Mistook His Wife for a Hat and Other Clinical Tales, is a collection of 24 detailed clinical narratives. In these tales, Sacks educates readers about neurologic syndromes by sharing the story of how a patient’s unusual symptoms manifested in their life and he came to figure out their cause through astute history taking and diagnostic tests. As Eric Cassell notes in The Nature of Suffering and the Goals of Medicine: “Medical stories are different from every day stories in one critical respect: they always have at least two characters—a person and that person’s body.” I would add, with the exception of some very introspective medical memoirs, there is a third character, the doctor or healer. In this essay I examine how the choices Sacks makes around these three characters in the titular story contribute to his effectiveness as a writer and his influence in the medical community, and what they reveal about his relationship to patients and goals as a neurologist.
These three major characters all show up in the first paragraph. In the first sentence, we are introduced to Dr. P, the person, as an accomplished musician and a distinguished teacher at a local school of music. In the second sentence, the body, the physical manifestations of illness are introduced as “certain strange problems” which are more fully described through the actions and misperceptions of Dr. P making up the bulk of the paragraph. At the end of this paragraph an ophthalmologist recognizes that the problem is not one of the eye, but of the brain, and sends him to a neurologist, Dr. Sacks.
Regarding character, this first paragraph is a microcosm of the whole work and the strengths and weaknesses of Sacks’ writing. Dr. P, the person, is mentioned only briefly and superficially. In fact, in the rest of the story we learn only a few more details about his life, for example that he has a wife and certain details of his home. It is striking how little we learn about Dr. P as a person. I think it particularly telling that when, at the end of his clinical description, Sacks starts a paragraph with, “The testing I had done so far told me nothing about Dr. P’s inner world.” He then launches into description of the neurologic manifestations on internal visual imagery (as opposed to vision of the external world) rather than anything about the emotional, spiritual, or social dimensions of his life, or the impact this illness has on Dr. P as an individual.
The vast majority of words in this tale concern Dr. P’s body, and in particular the function and dysfunction of a small part of his brain, the right fusiform gyrus. This is where Sacks’ contagious passion, intellectual curiosity, and strengths as a writer shine through. Here we see his characteristic thick and engaging descriptions of the behaviors of Dr. P (e.g. “he reached out his hand and took hold of his wife’s head, tried to lift it off, to put it on”), his use of metaphor (e.g. “seeing only details, which he spotted like blips on a radar screen”), and his personal reactions to these puzzling phenomenon (e.g. “I must have looked aghast”). It is also the heart of the story’s plot, namely how Sacks discovers the identity of the mischievous body part through his conversations and observations of it. One could in fact substitute “Dr. P’s visual cortex” for “Dr. P” throughout the tale with little loss in sense or meaning. In this dance, Dr. P the person is merely the container and informant for his brain, the central character and antagonist of the tale.
This leaves Sacks himself to fill the role of protagonist, the heroic neurologic detective who not only solves the case but advances the cause of science in confronting humanity’s ills. Like a good detective story, it is Sacks’ actions, queries, perceptiveness, and powers of deduction that move the story to its resolution. Here Sacks teaches the reader about the practice and art of neurology, the standard approach to history and examination, and the need for creativity in conversation and observation to uncover and understand new symptoms. Sacks’ success in his portrayal of this character not only make his tales endearing, but has led the public and media to see him as a “path-breaking researcher” and “clinician of compassion.”
Sacks’ formula has a deep history and forms the bedrock of modern neurology. In the 19th century, clinician-scientists in this new field collected histories of people with similar symptoms and then looked to see what shared alterations in their nervous system could explain the symptom, often at autopsy. The names of these pioneers are immortalized in eponymous diseases (e.g. Guillain-barre syndrome) and brain areas (e.g. Broca’s area). Sacks was not only aware of this history, but enthralled with the original writing. In Hallucinations he describes a revelation that his purpose in life was to bring “the best of mid-Victorian science and medicine” into modern times through his writing. In A Leg to Stand On he states his ambition to create a new field of neurology, what he termed “a neurology of the soul”, that would combine deep personal histories with neuroscience to elucidate the workings of the mind. He also suggested that this work would somehow lead to better treatments, but this aspiration seemed to be a vague humanistic add-on to justify his intellectual pursuits.
As a writer, there is no question of Sacks’ importance and influence. In my own field of neurology, he has done more than any other individual to popularize this field in the public imagination, to draw students to the fields of neurology and neuroscience, and to inspire a generation of physician-writers. As a physician and researcher, however, I find myself increasingly aware of the large gulf between Sacks the authored character, and Sacks the doctor and scientist. My disillusionment with Sacks began soon after I started my neurology residency where I was surprised to see that his name and work were discussed only in the context of popular culture. As I dug deeper, I saw that he had done no real research to advance the field and that most of his cases were discoveries only to him, not to the field. Prosopagnosia, the technical term for Dr. P’s inability to recognize faces, was first described in the late 1800’s and was well-known by most neurologists at the time of Sacks’ publication. Sacks in facts admits to becoming aware of “the rather extensive literature” only after his initial publication and blames this oversight on the literature “being so scattered… as to be easily overlooked” rather than his own shortcomings as a neurologist or researcher.
More troubling to me though is Sacks’ relationship to his patients as people. Towards the end of the tale, Dr. P says, “you find me an interesting case, I perceive. Can you tell me what you find wrong, make recommendations?” Sacks’ response is baffling. He tells Dr. P “I can’t tell you what I find wrong but I can tell you what I find right. You are a wonderful musician. What I would prescribe, in a case such as yours, is a life which consists entirely of music.” What is Dr. P to do with this prescription? How does he feel after spending days talking to Dr. Sacks and being left with only this useless aphorism? His failure to meaningfully help his patients support critics and disability rights activists who see Sacks as voyeuristically using his patients in a modern freak show. At a fundamental level, a careful analysis of his use of character reveals that he misses the essence of true compassion in his tales, namely to suffer with, an experience that requires one to get to know the soul of another, not merely their brain or body. While his may be an extreme example, many in the medical world prefer to relate primarily to the bodies of their patients. I believe this focus, often unconscious, is driven by a healthy fascination with physiology, but also by a fear of the uncomfortable and messy truths of suffering. Unfortunately, by conflating the person with the body they also miss the gifts of deep compassion, which include not only the healing of the patient but of connecting with their own humanity.
References:
Lisa Appignanesi, Clinician of compassion: Oliver Sacks opened a window to the extraordinary, (The Guardian, August 30, 2015).
Eric Cassell, The Nature of Suffering and the Goals of Medicine, 2nd Edition (New York: Oxford University Press, 2004), pg. 106.
Leonard Cassuto, Oliver Sacks: The PT Barnum of the postmodern world?, (American Quarterly, Volume 52, Issue 2), pgs. 326-333.
H. Hecean and R. Angelergues, Agnosia for faces (Prosopagnosia), (JAMA Neurology, Volume 7, Issue 2, 1962), pgs. 92-100.
Oliver Sacks, A Leg to Stand On, (New York: Summit Books, 1984), pg. 219.
Oliver Sacks, Hallucinations, (Toronto: Alfred A. Knopf, 2012), pg. 120.
Oliver Sacks, The Man who Mistook His Wife for a Hat and Other Clinical Tales, (New York: Summit Books, 1985), pgs. 7-21.
PBS News Desk, Oliver Sacks, neurologist and acclaimed author, dies at 82, (www.pbs.org/newshour/nation, August 30, 2015).