The Neurology of the Soul and the Patient’s Case History – Part 2

I hadn’t intended to do a Part 2, but writing about The Neurology of the Soul and the Patient’s Case History took me back to Oliver Sacks and his Facebook page, posthumously managed by the Oliver Sacks Foundation. It was there that I learned that the most famous “Hat” book by a doctor not named Seuss was released in September with a new preface that Oliver had written as an essay a couple of years ago, but had not been published until now.

From the new (2013) Preface: “The patients I described in Hat are never far from mind, and I continue to make new connections to their stories. Lilian Kallir, a renowned pianist, wrote to me some fifteen years after Hat was published, saying that she had lost the ability to recognize objects around her. She compared herself with Dr. P, though her ways of dealing with her visual problems of visual recognition were quite different from his. Lilian had a condition called posterior cortical atrophy, a term introduced years after Hat was published, to describe a specific Alzheimer-like syndrome.” (I blogged about Lilian’s story, recounted in The Mind’s Eye, here.)

Oliver continues: “I no longer agree with some of the things I wrote in Hat, and in many cases I have, over time, come to look at these patients in, I hope, a more nuanced way. But for me, they all remain alive, their stories expanding and revising as all of ours do … Thus when I came to publish my own case histories in the 1970s and 1980s, it was virtually impossible to do so in medical journals, which required charts and tables, and ‘objective’ language. Longer, more personal, detailed case histories were considered archaic and ‘unscientific’. This is beginning to change again – many medical schools have introduced courses in Narrative Medicine, and whole generations of younger neurologists see the case history as a crucial part of medicine.”

Dr. Sacks concludes: “With the rise of neuroscience and all its wonders, it is even more important now to preserve the personal narrative, to see every patient as a unique being with his own history and strategies for adapting and surviving. Though our insights may evolve and change, the phenomenology of human sickness and health remains fairly constant, and case history, careful and detailed descriptions of individual patients, can never become obsolete.”

It is in that vein, as Editor-in-Chief of Vision Development & Rehabilitation, that our journal continues to accord great value to Perspective pieces and Case Reports. As proud as we are of the clinical studies that our field is increasingly publishing, we will never lose sight of the power of the clinical narrative.

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