PART I Losses1 The man mistook his wife for a hatHe also appeared to have decided that the examination was over and started to look around for his hat. He reached out his hand and took hold of his wife’s head, tried to lift it off, to put it on. He had apparently mistaken his wife for a hat! His wife looked as if she was used to such things.But in Dr P.’s case it is precisely the cortex that was damaged, the organic prerequisite of all pictorial imagery. Interestingly and typically he no longer dreamed pictorally—the ‘message’ of the dream being conveyed in nonvisual terms.2 The lost marinerKorsakov’s syndrome: is a neurological disorder caused by a lack of thiamine (vitamin B1) in the brain. There are six major symptoms of Korsakoff's syndrome:anterograde amnesia; retrograde amnesia; severe memory loss; confabulation, that is, invented memories which are then taken as true due to gaps in memory sometimes associated with blackouts;minimal content in conversation; lack of insight; apathy - the patients lose interest in things quickly and generally appear indifferent to change.I have known Jimmie now for nine years—and neuropsychologically, he has not changed in the least.He still has the severest, most devastating Korsakov’s, cannot remember isolated items for more than a few seconds, and has a dense amnesia going back to 1945. But humanly, spiritually, he is at times a different man altogether—no longer fluttering, restless, bored, and lost, but deeply attentive to the beauty and soul of the world, rich in all the Kierkegaardian categories—and aesthetic, the moral, the religious, the dramatic. I had wondered, when I first met him, if he was not condemned to a sort of.3 The disembodied lady “Something awful’s happened,’ she mouthed, in a ghostly flat voice. ‘I can’t feel my body. I feel weird—disembodied.”“She continues to feel, with the continuing loss of proprioception, that her body is dead, not-real, not-hers—she cannot appropriate it to herself. She can find no words for this state, and can only use analogies derived from other senses: ‘I feel my body is blind and deaf to itself ...”But her situation is, and remains, a ‘Wittgensteinian’ one. She does not know ‘Here is one hand’— her loss of proprioception, her de-afferentation, has deprived her of her existential, her epistemic, basis—and nothing she can do, or think, will alter this fact. She cannot be certain of her body—what would Wittgenstein have said, in her position?4 The man who fell out of bedWhen I asked him what happened at night he said quite openly that when he woke in the night he always found that there was a dead, cold, hairy leg in bed with him which he could not understand but could not tolerate and he, therefore, with his good arm and leg pushed it out of bed and naturally, of course, the rest of him followed.He was such an excellent example of this complete loss of awareness of his hemiplegic limb but, interestingly enough, I could not get him to tell me whether his own leg on that side was in bed with him because he was so caught up with the unpleasant foreign leg that was there.5 Hands A patient with perfect elementary sensations in the hands, but, apparently, no power to “integrate these sensations to the level of perceptions that were related to the world and to herself; no power to say, ‘I perceive, I recognize, I will, I act’, so far as her ‘useless’ hands went. 6 Phantoms7 on the level In speaking of such a spirit level, Mr MacGregor had hit on a fundamental analogy, a metaphor for an essential control system in the brain. Parts of the inner ear are indeed physically—literally—like levels; the labyrinth consists of semicircular canals containing liquid whose motion is continually monitored. But it was not these, as such, that were essentially at fault; rather, it was his ability to use his balance organs, in conjunction with the body’s sense of itself and with its visual picture of the world. Mr MacGregor’s homely symbol applies not just to the labyrinth but also to the complex integration of the three secret senses: the labyrinthine, the proprioceptive, and the visual. It is this synthesis that is impaired in Parkinsonism.8 Eyes rightShe has totally lost the idea of ‘left’, with regard to both the world and her own body.9 The President's speech aphasia: loss of ability to understand or express speech. “One can lie with the mouth,’ Nietzsche writes, ‘but with the accompanying grimace one nevertheless tells the truth.’ To such a grimace, to any falsity or impropriety in bodily appearance or posture, aphasiacs are preternaturally sensitive. 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.In this, then, lies their power of understanding—understanding, without words, what is authentic or inauthentic. Thus it was the grimaces, the histrionisms, the false gestures and, above all, the false tones and cadences of the voice, which rang false for these wordless but “immensely sensitive patients. It was to these (for them) most glaring, even grotesque, incongruities and improprieties that my aphasic patients responded, undeceived and undeceivable by words.
PART II Excess10 Tourette's 11 Cupid diseaseThere may be an immense latent period between the primary infection and the advent of neurosyphilis, especially if the primary infection has been suppressed, not eradicated. I had one patient, treated with Salvarsan by Ehrlich himself, who developed tabes dorsalis—one form of neurosyphilis—more than fifty years later.What a paradox, what a cruelty, what an irony, there is here— that inner life and imagination may lie dull and dormant unless released, awakened, by an intoxication or disease!Precisely this paradox lay at the heart of Awakenings; it is responsible too for the seduction of Tourette’s (see Chapters Ten and Fourteen) and, no doubt, for the peculiar uncertainty which may attach to a drug like cocaine (which is known, like L-Dopa, or Tourette’s, to raise the brain’s dopamine). Thus Freud’s startling comment about cocaine, that the sense of well-being and euphoria it induces ‘. . . in no way differs from the normal euphoria of the healthy person ... In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug’.The same paradoxical valuation may attach to electrical stimulations of the brain: there are epilepsies which are exciting and addictive—and may be self-induced, repeatedly, by those who are prone to them (as rats, with implanted cerebral electrodes, compulsively stimulate the ‘pleasure-centers’ of their “own brain); but there are other epilepsies which bring peace and genuine well-being. A wellness can be genuine even if caused by an illness. And such a paradoxical wellness may even confer a lasting benefit. 12 A matter of IdentityWhat is it like for Mr Thompson? Superficially, he comes over as an ebullient comic. People say, ‘He’s a riot.’ And there is much that is farcical in such a situation, which might form the basis of a comic novel. It is comic, but not just comic—it is terrible as well. For here is a man who, in some sense, is desperate, in a frenzy. The world keeps disappearing, losing meaning, vanishing—and he must seek meaning, make meaning, in a desperate way, continually inventing, throwing bridges of meaning over abysses of meaninglessness, the chaos that yawns continually beneath him.