What would it be like, Oliver Sacks wonders, to lose one’s memory? Sacks recalls a patient named Jimmie G., who was admitted to a home for the elderly in 1975, when he was forty-nine years old. Jimmie was friendly and eager to cooperate with Sacks. He knew his name, birthday, and hometown, and could tell Sacks about his early life, including his time serving in World War II. Jimmie’s memories ended with the 1950, howevers: speaking in the present-tense, he told Sacks about Harry Truman being the president of the United States. Jimmie informed Sacks that he was nineteen years old. What Sacks did next was, he admits, a mistake—he took Jimmie to a mirror and asked him to look at his own face. Jimmie immediately became distressed—he wondered if he was in a nightmare. But less than two minutes later, Jimmie greeted Sacks as if meeting him for the first time. He seemed to have no memory of Sacks, although he immediately identified Sacks as a “doc.”
Evidently, Jimmie G. lacks a normal ability to make new memories, with the result that he can barely remember anything for longer than a couple seconds (notice, however, that Jimmie can vaguely remember Sacks, suggesting that his long-term memory is impaired, but not totally gone). Evidently, there was a point in Jimmie’s life when his memory was working normally, which is why Jimmie can remember Truman, his childhood, etc. The passage raises the first of many ethical questions surrounding Sacks’s patients: if a patient has a serious delusion about their reality, should Sacks disrupt the illusion? Sacks seems to recognize that showing Jimmie his true age was a mistake, suggesting that in some cases doctors shouldn’t interfere with their patients’ illusions unless absolutely necessary.
Sacks proceeded to run some tests on Jimmie G. Jimmie was smart, and could beat Sacks at games. He could also retain faint memories of the recent past—for example, when Sacks played tic-tac-toe with Jimmie, Jimmie could recall having played the game with “some doctor … a while back.” Jimmie could recall scientific knowledge, such as the weights of the elements, but was ignorant of any science past the 1940s—when Sacks told him that men had walked on the moon, for instance, Jimmie laughed.
As with Dr. P. in Chapter One, Sacks runs tests and examines Jimmie G. with great scientific rigor, but only after he’s gotten a sense for Jimmie’s character. Sacks’s tests and questions confirm what he already hypothesized: Jimmie is an intelligent person, but he’s virtually incapable of remembering events past the 1940s.
Oliver Sacks hypothesized that Jimmie G. suffered from Korsakov’s Syndrome, a rare condition, often brought on by alcohol, which degenerates the parts of the brain associated with memory. A. R. Luria had diagnosed many patients with a condition whose symptoms were similar to Korsakov’s, but whose cause, Luria believed, was the growth of cerebral tumors. Sacks’s wondered what could have caused Jimmie’s mental deterioration—could it have been alcohol consumption, or perhaps a tumor? Sacks ran various tests on Jimmie, but could find nothing unusual in his brain. Then he found a doctor’s report from 1971, explaining that Jimmie was suffering from brain disease “due to alcohol” (the report didn’t specify what this meant). Sacks managed to contact Jimmie’s brother, who explained that Jimmie—with whom he was no longer close—was a heavy drinker. In 1971, Jimmie’s brother had visited Jimmie, and found that Jimmie could no longer recognize him.
Sack’s diagnosis of Jimmie G. is more thorough than his diagnosis for Dr. P. in Chapter One; he not only determines the precise syndrome that’s caused Jimmie G.’s loss of memory, but also determines the cause of the syndrome. Like any good scientist, Sacks begins with a hypothesis and then strengthens his hypothesis by accumulating evidence for it, eventually determining that Jimmie’s alcohol consumption impaired his memory.
Oliver Sacks contacted A. R. Luria, and asked him for his opinion about Jimmie G. Luria theorized that, even though Jimmie G.’s cerebral deterioration hadn’t become serious until the 70s, this deterioration retroactively erased most of his memories after 1945. Luria encouraged Sacks to do “whatever your ingenuity and your heart suggest” for Jimmie, adding, “a man does not consist of memory alone.” Sacks spent more time with Jimmie, and watched Jimmie begin to develop a sense of familiarity with his new home. As the years went on, Jimmie never developed a deep emotional attachment to anyone in the hospital, although he was very friendly. The only person he recognized was his brother, who visited him occasionally. Jimmie’s brother’s visits were always deeply moving—Jimmie would wonder why his brother had aged so quickly.
Luria continues to act as a friend and a mentor for the young, relatively inexperienced Sacks. But notice that Luria’s advice isn’t purely medical; in addition, he gives Sacks moral and even spiritual advice about how to treat Jimmie G. In so doing, Luria confirms one of Sacks’s most important points: the responsibility of the neurologist is not, as many neurologists suppose, simply to measure and test patients, but also to understand patients’ lives and emotional situations, and to respect their dignity. Sacks makes a diagnosis for Jimmie, but he also comes to understand the tragedy of Jimmie’s life—he’s alienated from his closest friends and family.
Oliver Sacks once asked Jimmie how he felt about life, and Jimmie answered, “I haven’t felt alive for a very long time.” Sacks came to understand that Jimmie had lost his self—a loss that was especially tragic because Jimmie couldn’t understand that it had occurred in the first place. However, Sacks also noticed that when Jimmie went to chapel, he became very somber. He would take Communion, and in that moment, his spirit would align “with the spirit of the Mass.” Here, Jimmie’s lack of memory helped him become totally absorbed in the act of worship.
Here, Sacks poses one of the central questions of his book: what is the “self?” As Sacks seems to understand it, the self consists of more than just the ability to live, think, and have memories: to have a self, a human being must also make connections with other people, and with the external world in general. Jimmie’s condition leaves him incapable of making even the simplest connections with other people, but Catholic Mass helps him connect with the institutions and traditions of the church, providing him with a sense of peace. The fact that Sacks is posing such profound philosophical questions suggests that his book’s scope is much broader than just science.
Jimmie G. had no understanding of time in the sense of days, months, and years, but he had a deep understanding of “intentional time,” in the sense that his emotions oriented him from moment to moment. For example, during Mass, he was perfectly attuned to the peaceful mood of the ceremony, and would continue in this mood all day. Jimmie’s was the most severe case of Korsakov’s that Sacks has ever seen, but Sacks has realized that Jimmie isn’t lost in a constant state of flux because of his lack of memory. In some ways, Jimmie is more at peace than other human beings—with the help of religion and ceremony, he’s preserved his dignity and his spirit.
Jimmie’s participation in Mass not only provides him with a lasting sense of peace and somberness; it orients him in the world. In a way, Mass gives Jimmie an especially intense version of the feeling that it provides for many Catholics—a sense that they’re one small part of a much bigger force. Jimmie, who lives almost wholly in the present, thus regains a sense of inner composure here, adapting to his neurological condition.
In a Postscript, Sacks discusses recent scholarship on Korsakov’s. Alcoholic deterioration is only one potential cause of memory loss—others include head injury or impaired blood flow to the brain. In a similar disorder called Transient Global Amnesia (TGA), patients may experience severe temporary amnesia, especially retrograde amnesia. Sacks has researched patients who experience temporary visual amnesia—a condition in which the patient briefly loses the ability to see, but also the memory of what it means to see.
For most of the chapters in the book, Sacks uses the Postscript to discuss some relevant medical questions (while leaving the more abstract, philosophical matters for the chapter itself). Jimmie G.’s situation may be rare, but it raises some new, important questions about the causes and long-term effects of amnesia, for which thorough analysis of other patients is required.
In 1983, one hospitalized patient with Korsakov’s, Stephen R., was taken back to his hometown. In his home, Stephen felt comfortable, even though his memories of home ended in the 1970s. He was confused with some of the changes in his hometown, such as the building of a new supermarket, and found it odd that some of his friends looked older than he remembered them being. The most painful part of Stephen’s life was returning to the hospital after his hometown visits—by this time, Stephen had completely forgotten about being in the hospital. Although Jimmie G. found peace, Stephen “has a gaping time-wound, an agony that will never heal.”
There’s no rule that says that patients with serious neurological disorders are all like Jimmie G. (i.e., they don’t all find a way to achieve peace). Some, like Stephen R., live in a constant, nightmarish state, in which they’re bombarded with unfamiliar sensory data—a condition that Sacks aptly likens to having a wound that will never heal.