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Some of the most interesting, yet often limited clinical evidence comes from so called case studies. A case study offers a unique and thorough view of the disease in question, especially of how it affects one specific individual. Although intriguing, a case study can’t be considered reliable proof for forming or changing clinical guidelines or practices, due to its lack of statistical significance, or statistics in general. You see, big clinical studies, for example, are designed to predict how the majority would react to a certain drug, leaving the rare ones marginalized. Case studies, on the other hand, are meant exactly for the ones that “don’t fit in”, but also for the ones that are simply so rare it’s impossible to draw statistically supported conclusions. It’s the rare ones that bring case studies to the spotlight, and they make great teaching material for both professors and students.
Psychiatry and neurology are the two fields of medicine where one can often stumble upon very rare cases or diseases and are therefore filled with case studies by individual doctors. Many of them meet so many patients with the rarest of diseases, and some decide to summarize those cases and their professional opinions in a book. One such book is called “The Man Who Mistook His Wife for a Hat – and Other Clinical Tales” and was written by the profound neurologist Oliver Sacks in 1985.
In this book, Oliver Sacks describes in details some of the most interesting patients he encountered during his career, but does that in a very seducing way. He doesn’t just talk about the diseases per se, but paints a picture of the patients and their lives, brining them closer to the reader. In my opinion, he does a remarkable job in doing so, because we often get stuck on the pathophysiology and the morbid symptoms and forget that behind that disease stands a human being with a life that is very often forgotten, with a family that’s desperate and with passions that usually died with the rise of the disease. Therefore, Sacks case studies are anything but usual – he always starts with the story of how that patient even got to him, what brought him (or who?), describes the first encounter and his raw thoughts very thoroughly, he doesn’t hide the disappointment when he realizes just how doomed the patient is or what he or she has already hone through in their lives. Nevertheless, he still comments on pathology and pathophysiology of the diseases, comparing them to some of his previous cases or even with the cases of his colleagues.
The short stories about the patients are divided in roughly 4 sections, depending on the region of the brain that’s problematic and depending on the general type of the disease based on the symptoms. The title of the book, for example, got a name after a patient whose perception is gone and he starts thinking of object as people, even sees his own wife as a hat. In each case study, Sacks goes through his proposed curing protocols, which are almost always doomed to failure.
I could talk about each of the patients Sacks describes, and would love too, but since that would be a criminal amount of spoilers, I’m going to have to invite all of you who decide to give this book a try on a group therapy over a cup of coffee (based on the stories of and about some of the patients, I think we all are gonna need one after you finish reading it). Although the book is a page turner, it’s extra good over a cup of hot tea on a cold rainy evening and was therefore worth the wait for me to represent it to you in the middle of the autumn. I hope I made at least one of you interested in reading it and I’m especially looking forward to hearing your comments on the book, if you have (or will have) any.