It is, then, less deficits, in the traditional sense, which have engaged my interest than neurological disorders affecting the self. Such disorders may be of many kinds—and may arise from excesses, no less than impairments, of function—and it seems reasonable to consider these two categories separately. But it must be said from the outset that a disease is never a mere loss or excess—that there is always a reaction, on the part of the affected organism or individual, to restore, to replace, to compensate for and to preserve its identity, however strange the means may be: and to study or influence these means, no less than the primary insult to the nervous system, is an essential part of our role as physicians.
‘Well, Dr. Sacks,’ he said to me. ‘You find me an interesting case, I perceive. Can you tell me what you find wrong, make recommendations?’
‘l can't tell you what I find wrong,’ I replied, ‘but I'll say what I find right. You are a wonderful musician, and music is your life. What I would prescribe, in a case such as yours, is a life which consists entirely of music. Music has been the center, now make it the whole, of your life.’
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.’
If Jimmie was briefly ‘held’ by a task or puzzle or game or calculation, held in the purely mental challenge of these, he would fall apart as soon as they were done, into the abyss of his nothingness, his amnesia. But if he was held in emotional and spiritual attention—in the contemplation of nature or art, in listening to music, in taking part in the Mass in chapel—the attention, its ‘mood’, its quietude, would persist for a while, and there would be in him a pensiveness and peace we rarely, if ever, saw during the rest of his life at the Home.
This unquestionability of the body, its certainty, is, for Wittgenstein, the start and basis of all knowledge and certainty. Thus, in his last book (On Certainty), he opens by saying: ‘lf you do know that here is one hand, we'll grant you all the rest.’ But then, in the same breath, on the same opening page: ‘What we can ask is whether it can make sense to doubt it’; and, a little later, ‘Can I doubt its grounds for doubt are lacking!’
‘Easy!’ I said. ‘Be calm! Take it easy! I wouldn't punch that leg like that.’
‘And why not?’ he asked, irritably, belligerently.
‘Because it's your leg,’ I answered. ‘Don't you know your own leg?’
He gazed at me with a look compounded of stupefaction, incredulity, terror and amusement, not unmixed with a jocular sort of suspicion, ‘Ah Doc!’ he said. ‘You're fooling me! You're in cahoots with that nurse—you shouldn't kid patients like this!’
‘I'm not kidding,’ I said. ‘That's your own leg.’
He saw from my face that I was perfectly serious—and a look of utter terror came over him. ‘You say it's my leg, Doc? Wouldn't you say that a man should know his own leg?’
What wonderful possibilities of late learning, and learning for the handicapped, this opened up. And who could have dreamed that in this blind, palsied woman, hidden away, inactivated, over-protected all her life, there lay the germ of an astonishing artistic sensibility (unsuspected by her, as by others) that would germinate and blossom into a rare and beautiful reality, after remaining dormant, blighted, for sixty years?
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.
Here then was the paradox of the President's speech. We normals—aided, doubtless, by our wish to be fooled, were indeed well and truly fooled (‘Populus vult decipi, ergo decipiatur’). And so cunningly was deceptive word-use combined with deceptive tone, that only the brain-damaged remained intact, undeceived.
We might imagine, from a case of amnesia or agnosia, that there is merely a function or competence impaired—but we see from patients with hypermnesias and hypergnosias that mnesis and gnosis are inherently active, and generative, at all times; inherently, and—potentially—monstrously as well. Thus we are forced to move from a neurology of function to a neurology of action, of life. This crucial step is forced upon us by the diseases of excess—and without it we cannot begin to explore the ‘life of the mind’. Traditional neurology, by its mechanicalness, its emphasis on deficits, conceals from us the actual life which is instinct in all cerebral functions—at least higher functions such as those of imagination, memory and perception. It conceals from us the very life of the mind.
There followed three months of deep and patient exploration, in which (often against much resistance and spite and lack of faith in self and life) all sorts of healthy and human potentials came to light: potentials which had somehow survived twenty years of severe Tourette’s and ‘Touretty’ life, hidden in the deepest and strongest core of the personality. This deep exploration was exciting and encouraging in itself and gave us, at least, a limited hope. What in fact happened exceeded all our expectations and showed itself to be no mere flash in the pan, but an enduring and permanent transformation of reactivity. For when I again tried Ray on Haldol, in the same minute dose as before, he now found himself tic-free, but without significant ill-effects—and he has remained this way for the past nine years.
As this pattern became clear to him, and after discussing it with me, Ray made a momentous decision: he would take Haldol ‘dutifully’ throughout the working week, but would take himself off it, and ‘let fly’, at weekends. This he has done for the past three years. So now there are two Rays—on and off Haldol. There is the sober citizen, the calm deliberator, from Monday to Friday; and there is ‘witty ticcy Ray’, frivolous, frenetic, inspired, at week- ends.
Such a frenzy may call forth quite brilliant powers of invention and fancy—a veritable confabulatory genius—for such a patient must literally make himself (and his world) up every moment. We have, each of us, a life-story, an inner narrative—whose continuity, whose sense, is our lives. It might be said that each of us constructs and lives, a ‘narrative’, and that this narrative is us, our identities.
In all these states—‘funny’ and often ingenious as they appear—the world is taken apart, undermined, reduced to anarchy and chaos. There ceases to be any ‘center’ to the mind, though its formal intellectual powers may be perfectly preserved. The end point of such states is an unfathomable ‘silliness’, an abyss of superficiality, in which all is ungrounded and afloat and comes apart. Luria once spoke of the mind as reduced, in such states, to ‘mere Brownian movement’.
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.
All the transports described in this section do have more or less clear organic determinants (though it was not evident to begin with, but required careful investigation to bring out). This does not detract in the least from their psychological or spiritual significance.
Another week passed, and now Bhagawhandi no longer responded to external stimuli, but seemed wholly enveloped in a world of her own, and, though her eyes were closed, her face still bore its faint, happy smile. ‘She's on the return journey,’ the staff said. ‘She'll soon be there.’ Three days later she died—or should we say she ‘arrived’, having completed her passage to India?
Donald has not forgotten, or re-repressed, anything of the murder—if, indeed, repression was operative in the first place—but he is no longer obsessed by it: a physiological and moral balance has been struck.
But what of the status of the first lost, then recovered, memory? Why the amnesia—and the explosive return? Why the total black-out and then the lurid flashbacks? What actually happened in this strange, half-neurological drama? All these questions remain a mystery to this day.
Invested with this sense of ecstasy, burning with profound theophorous and philosophical significance, Hildegard’s visions were instrumental in directing her towards a life of holiness and mysticism. They provide a unique example of the manner in which a physiological event, banal, hateful or meaningless to the vast majority of people, can become, in a privileged consciousness, the substrate of a supreme ecstatic inspiration.
But of much greater interest, much more human, much more moving, much more ‘real’—yet scarcely even recognized in scientific studies of the simple (though immediately seen by sympathetic parents and teachers)—is the proper use and development of the concrete.
The concrete, equally, may become a vehicle of mystery, beauty and depth, a path into the emotions, the imagination, the spirit.
His innate, hereditary musical gift had clearly survived the ravages of meningitis and brain-damage—or had it? Would he have been a Caruso if undamaged? Or was his musical development, to some extent, a ‘compensation’ for brain-damage and intellectual limitations?
One speaks of ‘idiot savants’ as if they had an odd ‘knack’ or talent of a mechanical sort, with no real intelligence or understanding. This, indeed, was what I first thought with Martin—and continued to think until I brought in the Magnificat. Only then did it finally become clear to me that Martin could grasp the full complexity of such a work, and that it was not just a knack, or a remarkable rote memory at work, but a genuine and powerful musical intelligence.
This is the positive side—but there is a negative side too (not mentioned in their charts, because it was never recognized in the first place). Deprived of their numerical ‘communion’ with each other, and of time and opportunity for any ‘contemplation’ or ‘communion’ at all—they are always being hurried and jostled from one job to another—they seem to have lost their strange numerical power, and with this the chief joy and sense of their lives. But this is considered a small price to pay, no doubt, for their having become quasi-independent and ‘socially acceptable’.
Could he, with his fine eye, and great love of plants, make illustrations for botanical works or herbals? Be an illustrator for zoology or anatomy texts? (See the drawing overleaf he made for me when I showed him a textbook illustration of the layered tissue called ‘ciliated epithelium’.) Could he accompany scientific expeditions, and make drawings (he paints and makes models with equal facility) of rare species? […] 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.