FactsOfADrunkenMan.com Oliver Sacks - Man Who Mistook His Wife for a Hat

You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all . . . Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing … (I can only wait for the final amnesia, the one that can erase an entire life, as it did my mother's . . .) –Luis Bunuel

was it possible that he had really been 'de-souled' by a disease? 'Do you think he has a soul?' I once asked the Sisters. They were outraged by my question, but could see why I asked it. 'Watch Jimmie in chapel,' they said, 'and judge for yourself

There is little or no hope of any recovery in his memory. But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being-matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him.

What could we do? What should we do? There are no prescriptions,' Luria wrote, 'in a case like this. Do whatever your ingenuity and your heart suggest. There is little or no hope of any recovery in his memory. But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being-matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him.

Memory, mental activity, mind alone, could not hold him; but moral attention and action could hold him completely.

My colleague Dr. Leon Protass tells me of a case seen by him recently, in which a highly intelligent man was unable for some hours to remember his wife or children, to remember that he had a wife or children. In effect, he lost thirty years of his life- though, fortunately, for only a few hours. Recovery from such attacks is prompt and complete-yet they are, in a sense, the most horrifying of 'little strokes' in their power absolutely to annul or obliterate decades of richly lived, richly achieving, richly memo-ried life. The horror, typically, is only felt by others-the patient, unaware, amnesiac for his amnesia, may continue what he is doing, quite unconcerned, and only discover later that he lost not only a day (as is common with ordinary alcoholic 'blackouts'), but half a lifetime, and never knew it. The fact that one can lose the greater part of a lifetime has peculiar, uncanny horror.

Thus, in one patient under my care, a sudden thrombosis in the posterior circulation of the brain caused the immediate death of the visual parts of the brain. Forthwith this patient became completely blind-but did not know it. He looked blind-but he made no complaints. Questioning and testing showed, beyond doubt, that not only was he centrally or 'cortically' blind, but he had lost all visual images and memories, lost them totally-yet had no sense of any loss. Indeed, he had lost the very idea of seeing-and was not only unable to describe anything visually, but bewildered when I used words such as 'seeing' and 'light.' He had become, in essence, a non-visual being.

And if they cannot see one-this is especially true of our blind aphasiacs-they have an infallible ear for every vocal nuance, the tone, the rhythm, the cadences, the music, the subtlest modulations, inflections, intonations, which can give-or remove-verisimilitude to or from a man's voice.

the other hand, there is not just a surfeit of dopamine in the Touretter's brain, as there is not just a deficiency of it in the Parkinsonian brain. There are also much subtler and more widespread changes, as one would expect in a disorder which may alter personality: there are countless subtle paths of abnormality which differ from patient to patient, and from day to day in any one patient.

On the other hand, there is not just a surfeit of dopamine in the Touretter's brain, as there is not just a deficiency of it in the Parkinsonian brain. There are also much subtler and more widespread changes, as one would expect in a disorder which may alter personality: there are countless subtle paths of abnormality which differ from patient to patient, and from day to day in any one patient.

superficiality of his life: the way in which it is, in effect, reduced to a surface,

In Witty Ticcy Ray (Chapter Ten), I described a relatively mild form of Tourette's syndrome, but hinted that there were severer forms 'of quite terrible grotesqueness and violence'. I suggested that some people could accommodate Tourette's within a commodious personality, while others 'might indeed be "possessed", and scarcely able to achieve real identity amid the tremendous pressure and chaos of Tourettic impulses'.

Parkinsonism, indeed, cannot be fully seen, comprehended, in the clinic; it requires an open, complexly interactional space for the full revelation of its peculiar character (beautifully shown in Jonathan Miller's film Ivan). Parkinsonism has to be seen, to be fully comprehended, in the world, and if this is true of Parkinsonism, how much truer must it be of Tourette's.

As I drew closer I saw what was happening. She was imitating the passers-by-if 'imitation' is not too pallid, too passive, a word. Should we say, rather, that she was caricaturing everyone she passed? Within a second, a split-second, she 'had' them all.

Hume, as we have noted, wrote: I venture to affirm . . . that [we] are nothing but a bundle or collection of different sensations, succeeding one another with inconceivable rapidity, and in a perpetual flux and movement. Thus, for Hume, personal identity is a fiction-we do not exist, we are but a consecution of sensations, or perceptions.

The miracle is that, in most cases, he succeeds- for the powers of survival, of the will to survive, and to survive as a unique inalienable individual, are, absolutely, the strongest in our being: stronger than any impulses, stronger than disease. Health, health militant, is usually the victor.

The super-Touretter, then, is compelled to fight, as no one else is, simply to survive-to become an individual, and survive as one, in face of constant impulse. He may be faced, from earliest childhood, with extraordinary barriers to individuation, to becoming a real person. The miracle is that, in most cases, he succeeds- for the powers of survival, of the will to survive, and to survive as a unique inalienable individual, are, absolutely, the strongest in our being: stronger than any impulses, stronger than disease. Health, health militant, is usually the victor.

it does not-values, valuations, have nothing to do with etiology).

If God, or the eternal order, was revealed to Dostoievski in seizures, why should not other organic conditions serve as 'portals' to the beyond or the unknown?

Penfield was not only able to locate their origin in the temporal lobes, but was able to evoke the 'elaborate mental state', or the extremely precise and detailed 'experiential hallucinations' of such seizures by gentle electrical stimulation of the seizure-prone points of the cerebral cortex, as this was exposed, at surgery, in fully conscious patients. Such stimulations would instantly call forth intensely vivid hallucinations of tunes, people, scenes, which would be experienced, lived, as compellingly real, in spite of the prosaic atmosphere of the operating room, and could be described to those present in fascinating detail, confirming what Jackson described sixty years earlier, when he spoke of the characteristic 'doubling of consciousness':

And Mrs O'C. also saw and heard me, through the much profounder anamnestic seizure of her childhood in Ireland: 'I know you're there, Dr Sacks. I know I'm an old woman with a stroke in an old people's home, but I feel I'm a child in Ireland again-I feel my mother's arms, I see her, I hear her voice singing.' Such epileptic hallucinations or dreams, Penfield showed, are never phantasies: they are always memories, and memories of the most precise and vivid kind, accompanied by the emotions which accompanied the original experience. Their extraordinary and consistent detail, which was evoked each time the cortex was stimulated, and exceeded anything which could be recalled by ordinary memory, suggested to Penfield that the brain retained an almost perfect record of every lifetime's experience, that the total stream of consciousness was preserved in the brain, and, as such, could always be evoked or called forth, whether by the ordinary needs and circumstances of life, or by the extraordinary circumstances of an epileptic or electrical stimulation. The variety, the 'absurdity', of such convulsive memories and scenes made Penfield think that such reminiscence was essentially meaningless and random:

In her beautiful book on 'involuntary memories' (A Collection of Moments, 1970), Esther Salaman speaks of the necessity to preserve, or recapture, 'the sacred and precious memories of childhood', and how impoverished, ungrounded, life is without these.

We are all 'exiles from our past', she writes, and, as such, we need to recapture it.

Dostoievski had 'psychical seizures', or 'elaborate mental states' at the onset of seizures, and once said of these: You all, healthy people, can't imagine the happiness which we epileptics feel during the second before our fit… I don't know if this felicity lasts for seconds, hours or months, but believe me, I would not exchange it for all the joys that life may bring.

'It was the healthiest, happiest experience of my life. There's no longer a great chunk of childhood missing. I can't remember the details now, but I know it's all there. There's a sort of completeness I never had before.'

an ultimate serenity and security of spirit as is only given to those who possess, or recall, the true past.

Incontinent Nostalgia If I encountered

imbued with feeling and meaning-more readily, perhaps, than

The power of music, narrative and drama is of the greatest practical and theoretical importance. One may see this even in the case of idiots, with IQs below 20 and the extremest motor incompetence and bewilderment. Their uncouth movements may disappear in a moment with music and dancing-suddenly, with music, they know how to move.

box of matches on their table fell, and discharged its contents on the floor: '111,' they both cried simultaneously; and then, in a murmur, John said '37'. Michael repeated this, John said it a third time and stopped. I counted the matches-it took me some time-and there were 111.

A box of matches on their table fell, and discharged its contents on the floor: '111,' they both cried simultaneously; and then, in a murmur, John said '37'. Michael repeated this, John said it a third time and stopped. I counted the matches-it took me some time-and there were 111. 'How could you count the matches so quickly?' I asked. 'We didn't count,' they said. 'We saw the 111.'

'The pleasure we obtain from music comes from counting, but counting unconsciously. Music is nothing but unconscious arithmetic'

In this category were the Parks, highly gifted parents of a highly gifted, but autistic, child (see C.C. Park, 1967, and D. Park, 1974, pp. 313-23). The Parks' child 'Ella' was a talented drawer and was also highly gifted with numbers, especially in her earlier years. She was fascinated by the 'order' of numbers, especially primes. This peculiar feel for primes is evidently not uncommon. C.C. Park wrote to me of another autistic child she knew, who covered sheets of paper with numbers written down 'compulsively'. 'All were primes,'

He could do all of these-but, alas, he will do none, unless someone very understanding, and with opportunities and means, can guide and employ him. For, as the stars stand, he will probably do nothing, and spend a useless, fruitless life, as so many other autistic people do, overlooked, unconsidered, in the back ward of a state hospital.

Best Oliver Sacks - Man Who Mistook His Wife for a Hat