Read an extract from Will Self's introduction to the Picador Classic edition of The Man Who Mistook His Wife for a Hat, by Oliver Sacks. 

In Hallucinations, published in 2012, Oliver Sacks describes an experience he had when he was a newly qualified doctor in the late 1960s. Sacks was researching migraine, which he went on to write a book about (Migraine, 1970), and had on his own account ‘read dozens of articles about migraine and its possible basis’, but one book he took out of the rare books section of the medical library had a profound effect on him. Sacks read On Megrim by Edward Liveing MD in more or less a single sitting: ‘In a sort of catatonic concentration so intense that in ten hours I scarcely moved a muscle or wet my lips, I read steadily through the five hundred pages of Megrim. As I did so, it seemed to me almost as if I were becoming Liveing himself, actually seeing the patients he described. At times I was unsure whether I was reading the book or writing it.’ Sacks was transported by Liveing’s ‘humanity and social sensitivity’, which reminded him of Henry Mayhew’s pioneering social observations of the London poor, and was seamlessly integrated with the author’s own training in biology and the physical sciences.

Even as Sacks read on, wholly immersed, it occurred to him that Liveing’s On Megrim represented ‘the best of mid- Victorian science and medicine’, and that this was an approach to neurology – compassionate, humane, and above all deeply immersed in the narratives of individual patients’ lives – that had been lost in the dry, quantifiable abstractions of contemporary medical ‘literature’. Sacks began wondering who among his contemporaries was best suited to be the Liveing of the current era – who had ‘that mix of science and humanism that was so powerful in [him]’. Then it struck him with the force of an epiphany: ‘You silly bugger! You’re the man!’ That this experience took place after he had taken a massive dose of amphetamines is in some ways crucial – and in others quite irrelevant.

Writing about the organic basis of hallucinations in The Man Who Mistook His Wife for a Hat, Sacks remarks, ‘valuations have nothing to do with aetiology’, and whatever the aetiology of his career-defining hallucination, the fact is that when he came down from his amphetamine high, he did indeed set about writing not just a single book that would resurrect
this lost tradition, but a whole series of them. Sacks writes: ‘The joy I got from doing this was real – infinitely more sub- stantial than the vapid mania of amphetamines – and I never took amphetamines again.’

He may never have sought inspiration in this form of altered state again, but the fact remains that Sacks was the sort of physician unafraid to experiment on his own neurology and psyche; and also the sort of physician who gave full weight to such experiences – rather than viewing them as distinct from ‘ordinary’ or ‘normal’ consciousness. In the intervening years Sacks has published eleven books; nine are collected case histories and two are volumes of memoir. He has also contributed to a plethora of joint publications in book form, and submitted scores of articles to specialists and non-specialist publications alike. But whether writing for a professional audience or a general reader, Sacks’s output has remained remarkably consistent in its approach and – for want of a better term – its tone. The Man Who Mistook His Wife for a Hat falls comparatively early in the Sacks oeuvre; published in 1985, it brings together a number of case histories – and the insights they provoked – eight of which were initially published elsewhere in places as various as the New York Review of Books and The Lancet.

In his Preface, Sacks says of himself: ‘I am equally interested in diseases and people’; he goes on to root his approach to writing about this dyad in Hippocrates’s historical conception of the disease as having a ‘course’ that can be described in the form of a ‘pathography’. For Sacks only these narratives can give full weight to the experiential and existential character of illness – only they can adequately convey the ‘who’ as well as the ‘what’ of disease.