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What is the difference between abstract and concrete thought? How did the world of narrative help patient Rebecca cope with her inability to comprehend abstract ideas?
Psychologist Oliver Sacks discusses his patient Rebecca in his book The Man Who Mistook His Wife for a Hat. Due to an intellectual disability, Rebecca struggled to comprehend abstract thought yet she excelled at writing poetry because of her understanding of narrative.
Here is what Oliver Sacks had to say about abstract and concrete thought and the amazing story of Rebecca.
Abstract and Concrete Thought
Sacks believed that there was something profoundly moving about working with intellectually disabled patients. Much of this had to do with the distinctions between abstract and concrete thought. Broadly speaking, abstract thought deals with the world of ideas and concepts that don’t “exist” in the physical world. Concrete thought, meanwhile, concerns those things that do exist in the physical world. The concrete world is that of the tactile, particular, and immediate.
Individuals with intellectual disabilities often struggle to grasp abstraction. Instead, they inhabit a purely concrete world. Because they were freed from the encumbrances of abstraction, they had a quiet sense of completeness and innocence that was rarely found in “normal” people. Moreover, their world was often more intense and vivid, freed as it was from the encumbrances of abstraction.
This view of intellectual disability, however, was at odds with much traditional neurology at the time he was writing. Classic neurology saw the ability to comprehend abstract ideas as one of the crowning achievements of the human brain, a trait that separated it from the brains of other, lower organisms. Meanwhile, this school of thought viewed concreteness as primitive and regressed.
But, as we will see with the case histories to follow, such a view is misinformed. Concrete thinking is a crucial part of what it means to be human. Its absence can wreak havoc—to see the consequences of this, we don’t need to look any further than the story of Dr. P from Chapter 1, an otherwise intelligent man who nevertheless had no ability to understand the concrete world right in front of him and could only make sense of it in terms of stylized abstractions.
As we’ve seen with all of our cases, poor functioning in one area of the brain seems to lead to enhanced functioning and ability in another. Without abstraction, intellectually disabled patients can fully immerse themselves in the world of the concrete, amassing a dazzling mental collection of details and particulars.
Concrete thought is capable of expressing emotion and feeling just as poignantly and powerfully as abstract thought. We see some of the essential elements of our own humanity in studying the intellectually disabled.
Finding Meaning Through Narrative
Rebecca was a 19-year-old girl with severe intellectual disabilities. She had an IQ of 60 (90-110 is considered to be normal or average intelligence) and was unable to dress, read, write, or count, to list just a few of her limitations. Overall, she struggled with tasks that required abstract thought and seeing the “big picture.”
But Rebecca had an extraordinary capacity to understand stories and narrative and fully grasped the metaphors, symbols, and imagery contained within them—because symbols, after all, are just concrete objects representing abstract ideas. Indeed, story and symbol were the keys that Rebecca used to unlock the abstract mysteries of her world.
She had a great appetite for stories, frequently begging her grandparents to read to her. Sacks observed that it was not unlike how small children can understand ideas like empathy and love when they are represented in a story, but are unable to understand such abstract concepts when they are presented outside the context of a narrative.
Rebecca could even understand complex poetry and fully participate in the prayer services at her family’s Orthodox Jewish synagogue in New York—despite being otherwise unable to comprehend even the most basic verbal commands. She was liberated from her intellectual constraints when she entered the narrative-based world of literature and spirituality.
She had the soul and spirit of a poet; she was spiritually and emotionally complete, even if she was running an intellectual “deficit.” Rebecca could create narrative and meaning just as well as she could understand it, too. Sacks several times observed her conjure poetic imagery in wonderful, unexpected bursts when she was contemplatively looking at nature. Despite having no capacity to see abstract patterns or schema, she saw the real world with a clarity that few others could.
When her beloved grandmother died, Rebecca could only express her profound grief through allegory and metaphor—literary devices that are, of course, ways of linking the concrete world to the abstract world of ideas. She told Sacks, “It is winter, I feel dead”; “Part of me died with her”; “She’s gone to her Long Home.”
In working with Rebecca, Sacks found that treatment in traditional clinical settings did little for her. But when she enrolled in a special theatre group for the intellectually disabled, she thrived. Rebecca was able to make meaning and become complete by playing characters. Rebecca described her own condition in an apt simile: “I’m like a sort of living carpet…I come apart, I unravel, unless there’s a design…I must have meaning.”
Rebecca’s limitations concealed the parts of her that were preserved—and indeed, thriving. After his experience working with her, Sacks realized that neurology focused too much on deficits, with its diagnostic and treatment tools failing to properly account for the full powers of a human being.
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Here's what you'll find in our full The Man Who Mistook His Wife for a Hat summary:
- Neurologist Oliver Sacks' case studies on patients with neurological impairments
- The remarkable complexity of the human brain and its extraordinary capacity to adapt
- How Sacks' work with his patients shows the pitfalls of traditional thinking about neurological disorders