See also
Books by Oliver Sacks
Showing posts with label Oliver Sacks. Show all posts
Showing posts with label Oliver Sacks. Show all posts
Oliver Sacks talks about why is he still seeing his psychoanalyst after 46 years
In this video the British neurologist speaks about his analysis and how it has influenced him.
Migraine by Oliver Sacks
The Mind's Eye by Oliver Sacks
How does the brain perceive and interpret information from the eye?
And what happens when the process is disrupted?
In The Mind’s Eye, Oliver Sacks tells the stories of people who are able to navigate the world and communicate with others despite losing what many of us consider indispensable senses and abilities: the capacity to recognize faces, the sense of three-dimensional space, the ability to read, the sense of sight. For all of these people, the challenge is to adapt to a radically new way of being in the world – and The Mind’s Eye is testament to the myriad ways that we, as humans, are capable of rising to this challenge.
An Anthropologist on Mars: Seven Paradoxical Tales by Oliver Sacks
The Island of the Colour-blind by Oliver Sacks
On the Move: A Life by Oliver Sacks
With unbridled honesty and humour, Sacks shows us that the same energy that drives his physical passions - bodybuilding, weightlifting, and swimming - also drives his cerebral passions. He writes about his love affairs, both romantic and intellectual, his guilt over leaving his family to come to America, his bond with his schizophrenic brother, and the writers and scientists - Thom Gunn, A. R. Luria, W. H. Auden, Gerald M. Edelman, Francis Crick - who influenced him.
On the Move is the story of a brilliantly unconventional physician and writer - and of the man who has illuminated the many ways that the brain makes us human.
Awakenings by Oliver Sacks
Oaxaca Journal by Oliver Sacks
Since childhood Oliver has been fascinated by the ability of these primitive plants to survive and adapt in many climates. Oaxaca Journal is the enthralling account of his trip, alongside a group of fellow fern enthusiasts, to the beautiful province of Oaxaca, Mexico. Bringing together Oliver’s endless curiosity about natural history and the richness of human culture with his sharp eye for detail, this book is a captivating evocation of a place, its plants, its people, and its myriad wonders.
Musicophilia: Tales of Music and the Brain
Seeing Voices: A Journey into the World of the Deaf
A Leg to Stand On by Oliver Sacks
Uncle Tungsten: Memories of a Chemical Boyhood
Vintage Sacks
Vintage Sacks includes the introduction and case study “Rose R.” from Awakenings (the book that inspired the Oscar-nominated movie), as well as “A Deaf World” from Seeing Voices; “The Visions of Hildegard” from Migraine; excerpts from “Island Hopping” and “Pingelap” from The Island of the Colorblind; “A Surgeon’s Life” from An Anthropologist on Mars; and two chapters from Sacks’s acclaimed memoir Uncle Tungsten.
Oliver Sacks - Quotes
― Oliver Sacks, Musicophilia: La musique, le cerveau et nous
“Music can lift us out of depression or move us to tears - it is a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more - it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity.”
― Oliver Sacks
“My religion is nature. That’s what arouses those feelings of wonder and mysticism and gratitude in me.”
― Oliver Sacks
“If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self—himself—he cannot know it, because he is no longer there to know it.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“We speak not only to tell other people what we think, but to tell ourselves what we think. Speech is a part of thought.”
― Oliver Sacks, Seeing Voices
“If we wish to know about a man, we ask 'what is his story--his real, inmost story?'--for each of us is a biography, a story. Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us--through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives--we are each of us unique.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.”
― Oliver Sacks
“Language, that most human invention, can enable what, in principle, should not be possible. It can allow all of us, even the congenitally blind, to see with another person’s eyes.”
― Oliver Sacks
“Music is part of being human.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“To live on a day-to-day basis is insufficient for human beings; we need to transcend, transport, escape; we need meaning, understanding, and explanation; we need to see over-all patterns in our lives. We need hope, the sense of a future. And we need freedom (or, at least, the illusion of freedom) to get beyond ourselves, whether with telescopes and microscopes and our ever-burgeoning technology, or in states of mind that allow us to travel to other worlds, to rise above our immediate surroundings.
We may seek, too, a relaxing of inhibitions that makes it easier to bond with each other, or transports that make our consciousness of time and mortality easier to bear. We seek a holiday from our inner and outer restrictions, a more intense sense of the here and now, the beauty and value of the world we live in.”
― Oliver Sacks
“Waking consciousness is dreaming – but dreaming constrained by external reality”
― Oliver Sacks
“The inexpressible depth of music, so easy to understand and yet so inexplicable, is due to the fact that it reproduces all the emotions of our innermost being, but entirely without reality and remote from its pain...Music expresses only the quintessence of life and of its events, never these themselves.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“To be ourselves we must have ourselves – possess, if need be re-possess, our life-stories. We must “recollect” ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“he wanted to do, to be, to feel- and could not; he wanted sense, he wanted purpose- in Freud's words, 'Work and Love'.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“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.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“The brain is more than an assemblage of autonomous modules, each crucial for a specific mental function. Every one of these functionally specialized areas must interact with dozens or hundreds of others, their total integration creating something like a vastly complicated orchestra with thousands of instruments, an orchestra that conducts itself, with an ever-changing score and repertoire.”
― Oliver Sacks
“Music evokes emotion and emotion can bring it's memory.”
― Oliver Sacks
“Darwin speculated that “music tones and rhythms were used by our half-human ancestors, during the season of courtship, when animals of all kinds are excited not only by love, but by strong passions of jealousy, rivalry, and triumph” and that speech arose, secondarily, from this primal music.”
― Oliver Sacks
“There are, of course, inherent tendencies to repetition in music itself. Our poetry, our ballads, our songs are full of repetition; nursery rhymes and the little chants and songs we use to teach young children have choruses and refrains. We are attracted to repetition, even as adults; we want the stimulus and the reward again and again, and in music we get it. Perhaps, therefore, we should not be surprised, should not complain if the balance sometimes shifts too far and our musical sensitivity becomes a vulnerability.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“There is certainly a universal and unconscious propensity to impose a rhythm even when one hears a series of identical sounds at constant intervals... We tend to hear the sound of a digital clock, for example, as "tick-tock, tick-tock" - even though it is actually "tick tick, tick tick.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“إذا أردنا أن نعرف فلاناً فنحن نسأل : " ما قصته - قصته الحقيقية الأعمق ؟ - " لأن كل واحد منا هو سيرة وقصة . كل واحد منا هو حكاية فريدة يتم تركيبها باستمرار ودون وعي بواسطتنا ومن خلالنا وفينا من خلال إدراكاتنا ومشاعرنا وأفكارنا وأفعالنا وليس أقله بواسطة حديثنا وحكاياتنا المنطوقة . نحن لا نختلف عن بعضنا بعضاً كثيراً بيولوجياً وفسيولوجياً ، أما تاريخياً ، كقصص ، فكل من فريد !”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“The power of music, whether joyous or cathartic must steal on one unawares, come spontaneously as a blessing or a grace--”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“Music, uniquely among the arts, is both completely abstract and profoundly emotional. It has no power to represent anything particular or external, but it has a unique power to express inner states or feelings. Music can pierce the heart directly; it needs no mediation.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“But the saddest difference between them was that Zazetsky, as Luria said, 'fought to regain his lost faculties with the indomitable tenacity of the damned,' whereas Dr P. was not fighting, did not know what was lost. But who was more tragic, or who was more damned -- the man who knew it, or the man who did not?”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“At 11, I could say ‘I am sodium’ (Element 11), and now at 79, I am gold.”
― Oliver Sacks
“Dangerously well’— what an irony is this: it expresses precisely the doubleness, the paradox, of feeling ‘too well”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“One must go to Dostoievsky who experienced on occasion ecstatic epileptic auras to which he attached momentous significance, to find an adequate historical parallel.
"There are moments, and it is only a matter of five or six seconds, when you feel the presence of the eternal harmony ... a terrible thing is the frightful clearness with which it manifests itself and the rapture with which it fills you. If this state were to last more than five seconds, the soul could not endure it and would have to disappear. During these five seconds I live a whole human existence, and for that I would give my whole life and not think that I was paying too dearly …”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Given her deafness, the auditory part of the brain, deprived of its usual input, had started to generate a spontaneous activity of its own, and this took the form of musical hallucinations, mostly musical memories from her earlier life. The brain needed to stay incessantly active, and if it was not getting its usual stimulation..., it would create its own stimulation in the form of hallucinations.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“It really is a very odd business that all of us, to varying degrees, have music in our heads.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“And so was Luria, whose words now came back to me: ‘A man does not consist of memory alone. He has feeling, will, sensibility, moral being ... It is here ... you may touch him, and see a profound change.’ Memory, mental activity, mind alone, could not hold him; but moral attention and action could hold him completely.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“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.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Very young children love and demand stories, and can understand complex matters presented as stories, when their powers of comprehending general concepts, paradigms, are almost nonexistent.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Astounded—and indifferent—for he was a man who, in effect, had no ‘day before’.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“What an odd thing it is to see an entire species -- billions of people -- playing with, listening to meaningless tonal patterns, occupied and preoccupied for much of their time by what they call 'music.' (-- The Overlords, from Arthur C. Clarke's Childhood's End)”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“تصاب الحيوانات بالمرض, و لكن الإنسان فقط يمرض جذرياً
animals get diseases, but only man falls radically into sickness.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“...when the brain is released from the constraints of reality, it can generate any sound, image, or smell in its repertoire, sometimes in complex and "impossible" combinations".”
― Oliver Sacks
“Dr. Kertesz mentioned to me a case known to him of a farmer who had developed prosopagnosia and in consequence could no longer distinguish (the faces of) his cows, and of another such patient, an attendant in a Natural History Museum, who mistook his own reflection for the diorama of an ape”
― Oliver Sacks
“At the end of our visit, Fleisher agreed to play something on my piano, a beautiful old 1894 Bechstein concert grand that I had grown up with, my father's piano. Fleisher sat at the piano and carefully, tenderly, stretched each finger in turn, and then, with arms and hands almost flat, he started to play. He played a piano transcription of Bach's "Sheep May Safely Graze," as arranged for piano by Egon Petri. Never in its 112 years, I thought, had this piano been played by such a master-I had the feeling that Fleisher has sized up the piano's character and perhaps its idiosyncrasies within seconds, that he had matched his playing to the instrument, to bring out its greatest potential, its particularity. Fleisher seemed to distill the beauty, drop by drop, like an alchemist, into flowing notes of an almost unbearable beauty-and, after this, there was nothing more to be said.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“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. We see how the retarded, unable to perform fairly simple tasks involving perhaps four or five movements or procedures in sequence, can do these perfectly if they work to music—the sequence of movements they cannot hold as schemes being perfectly holdable as music, i.e. embedded in music. The same may be seen, very dramatically, in patients with severe frontal lobe damage and apraxia—an inability to do things, to retain the simplest motor sequences and programmes, even to walk, despite perfectly preserved intelligence in all other ways. This procedural defect, or motor idiocy, as one might call it, which completely defeats any ordinary system of rehabilitative instruction, vanishes at once if music is the instructor. All this, no doubt, is the rationale, or one of the rationales, of work songs.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Thus the feeling I sometimes have - which all of us who work closely with aphasiacs have - that one cannot lie to an aphasiac. He cannot grasp your words, and cannot be deceived by them; but what he grasps he grasps with infallible precision, namely the expression that goes with the words, the total, spontaneous, involuntary expressiveness which can never be simulated or faked, as words alone can, too easily.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“يمكننا أن نرى بسهولة في الآخرين ما لا نهتم أو نجرؤ على رؤيته في أنفسنا”
― Oliver Sacks, A Leg to Stand On
“One must drop all presuppositions and dogmas and rules - for there only lead to stalemate or disaster; one must cease to regard all patients as replicas, and honor each one with individual reactions and propensities; and, in this way, with the patient as one's equal, one's co-explorer, not one's puppet, one may find therapeutic ways which are better than other ways, tactics which can be modified as occasion requires.”
― Oliver Sacks, Awakenings
“The pleasure we obtain from music comes from counting, but counting unconsciously. Music is nothing but unconscious arithmetic.”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“But who was more tragic, or who was more damned—the man who knew it, or the man who did not?”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“الطبيبُ والمريضُ نظيران , يتّعلمُ كل منهما من الآخر و يساعده ويتوصلان معآ إلى معارف جديدة وعلاج *”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“And language, (...) is not just another faculty or skill, it is what makes thought possible, what seperates thought from nonthought, what seperates the human from the non human.”
― Oliver Sacks, Seeing Voices
“إذا كان لدينا الصبا ، والجمال ، والقوة ، والموهبة ، وإذا وجدنا الشهرة ، والثروة ، والحظوة ، والرضى ، فمن السهل أن نكون لطفاء ، وأن نلقى العالم بقلب ودود . لكن دعنا فقط نفقد الحظوة ، والجمال ، والقوة ، والصحة ؛ دعنا نجد أنفسنا مرضى ، وتعساء ، ومن دون أمل واضح بالشفاء ؛ حينها فقط ستُمتحَن قوة احتمالنا وشخصيتنا الأخلاقية ، إلى الحد الأقصى”
― Oliver Sacks, A Leg to Stand On
“Anatomists today would be hard put to identify the brain of a visual artist, a writer or a mathematician - but they would recognize the brain of a professional musician without moment's hesitation.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“This usually occurs at the moment when my head hits the pillow at night; my eyes close and … I see imagery. I do not mean pictures; more usually they are patterns or textures, such as repeated shapes, or shadows of shapes, or an item from an image, such as grass from a landscape or wood grain, wavelets or raindrops … transformed in the most extraordinary ways at a great speed. Shapes are replicated, multiplied, reversed in negative, etc. Color is added, tinted, subtracted. Textures are the most fascinating; grass becomes fur becomes hair follicles becomes waving, dancing lines of light, and a hundred other variations and all the subtle gradients between them that my words are too coarse to describe.”
― Oliver Sacks, Hallucinations
“When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate — the genetic and neural fate — of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.”
― Oliver Sacks
“WHILE MUSIC alone can unlock people with parkinsonism, and movement or exercise of any kind is also beneficial, an ideal combination of music and movement is provided by dance (and dancing with a partner, or in a social setting, brings to bear other therapeutic dimensions).”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“Patients with various other types of movement disorders may also be able to pick up the rhythmic movement or kinetic melody of an animal, so, for example, equestrian therapy may have startling effectiveness for people with parkinsonism, Tourette’s syndrome, chorea, or dystonia.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“إذا فقد رجلٌ رجلاً أو عيناً ، فهو يعرف أنه فقد رِجلاً أو عيناً. ولكن إذا فقد نفساً - نفسه- فليس بإمكانه أن يعرف ذلك، لأنه لم يعد موجوداً هناك ليعرف”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Some people with Tourette's have flinging tics- sudden, seemingly motiveless urges or compulsions to throw objects..... (I see somewhat similar flinging behaviors- though not tics- in my two year old godson, now in a stage of primal antinomianism and anarchy)”
― Oliver Sacks, An Anthropologist on Mars: Seven Paradoxical Tales
“I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.
Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”
― Oliver Sacks
“I have to remember, too, that sex is one of those areas—like religion and politics—where otherwise decent and rational people may have intense, irrational feelings.”
― Oliver Sacks, On the Move: A Life
“عيادة الطبيب أو جناح المستشفى ليس دائماً المكان الأفضل لملاحظة المرض - أو على الأقل ليس المكان الأفضل لملاحظة اضطراب يظهر ، إذا كان منشأه عضوياً ، بصورة اندفاع ، و تقليد ، و تشخيص ، و ردّ فعل ، و تفاعل قد يصل إلى درجة لا يمكن تصديقها تقريباً ..”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“يدعي الطب دوما أن التجربة هي الأختبار لعملياته وبالتالي كان أفلاطون محقا عندما قال إنه من أجل أن يصبح المرء طبيبا حقيقيا لابد أن يكون قد اختبر جميع الأمراض التي يأمل أن يعالجها وجميع الحوادث والحالات التي سيشخصها ... سأثق برجل كهذا ، لأن البقية يرشدوننا مثل الشخص الذي يرسم البحار والصخور والموانئ بينما يجلس إلى طاولته ويدير سفينته بأمان تام . اقذف به
في المشهد الحقيقي وستجده لا يعرف أين يبدأ
مونتيني”
― Oliver Sacks, A Leg to Stand On
“يحتاج الإنسان إلى قصة داخلية مستمرة للحفاظ على نفسه وهويته *”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“من السهل تذكر الأمور الجميلة في الحياة ، الأوقات التي يبتهج فيها قلب المرء وينفتح حين يكون كل شيء مطوقاً بالعطف والحب من السهل تذكر صفاء الحياة؛ كم كان المرء نبيلا وكريماً وشجاعاً في مواجهة المحن لكن من الأصعب أن نتذكر كم كم كنا مفعمين بالكره !”
― Oliver Sacks, A Leg to Stand On
“We have five senses in which we glory and which we recognise and celebrate, senses that constitute the sensible world for us. But there are other senses -- secret senses, sixth senses, if you will -- equally vital, but unrecognised, and unlauded. These senses, unconscious, automatic, had to be discovered.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Dr. P. may therefore serve as a warning and parable -- of what happens to a science which eschews the judgmental, the particular, the personal, and becomes entirely abstract and computational.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“A human being is not mindless or mentally deficient without language, but he is severely restricted in the range of his thoughts, confined, in effect, to an immediate, small world.”
― Oliver Sacks, Seeing Voices
“As Sicknes is the greatest misery, so the greatest misery of sicknes, is solitude...Solitude is a torment which is not threatened in hell itselfe.
-DONNE”
― Oliver Sacks, Awakenings
“Substituirile risipisera oare senzatia absentei trupului, despre care vorbea la început? Câtusi de putin. Ea continua sa simta, din cauza persistentei pierderii proprioceptiunii, ca trupul ei e mort, nereal, ca nu este al ei - nu poate pune stapânire pe propriul ei trup. Nu stie cum sa descrie aceasta stare, gaseste doar analogii derivate din alte simturi: «Simt ca trupul meu e orb si
mut fata de el însusi... nu are simtul de sine» - acestea sunt vorbele ei.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Perception is never purely in the present - it has to draw on experience of the past;(...).We all have detailed memories of how things have previously looked and sounded, and these memories are recalled and admixed with every new perception.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“إن العيادة و المختبر و جناح المستشفى مصمّمة جميعاً لكبح و تركيز السلوك ، إن لم يكن لإقصائه كلياً ..”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“She now receives love, attention, and invisible presents from a hallucinatory gentleman who visits faithfully each evening.”
― Oliver Sacks, Hallucinations
“يمكن لطفل أن يتابع الكتاب المقدس قبل أن يتابع إقيلدس, ليس لأن الكتاب المقدس أبسط (يمكن قول العكس) بل لأنه مطروح بأسلوب رمزي و قصصي”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“And I myself was wrung with emotion -- it was heartbreaking, it was absurd, it was deeply perplexing, to think of his life lost in limbo, dissolving.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“And then, as if thrown by a giant paintbrush, there appeared a huge, trembling, pear-shaped blob of the purest indigo. Luminous, numinous, it filled me with rapture: It was the color of heaven, the color, I thought, which Giotto had spent a lifetime trying to get but never achieved—never achieved, perhaps, because the color of heaven is not to be seen on earth.”
― Oliver Sacks, Hallucinations
“judgment is the most important faculty we have. An animal, or a man, may get on very well without ‘abstract attitude’ but will speedily perish if deprived of judgment. Judgment must be the first faculty of higher life or mind—yet it is ignored, or misinterpreted, by classical (computational) neurology. And if we wonder how such an absurdity can arise, we find it in the assumptions, or the evolution, of neurology itself.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Ucho w liczbach:" A youthful ear can hear ten octaves of sound, spanning a range from about thirty to twelve tousand vibrations a second. The avarege ear can distinguish sounds a seventeenth of a tone apart. From top to bottom we hear about fourtheen tousend discriminable tones.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“Studies by Andrew Newberg and others have shown that long-term practice of meditation produces significant alterations in cerebral blood flow in parts of the brain related to attention, emotion, and some autonomic functions.”
― Oliver Sacks, Hallucinations
“I never took amphetamines again—despite sometimes-intense longings for them (the brain of an addict or an alcoholic is changed for life; the possibility, the temptation, of regression never go away).”
― Oliver Sacks, On the Move: A Life
“a quiet despair..!!”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“could not be hypnotized, not because of any ‘resistance,’ but because of his extreme amnesia, which caused him to lose track of what the hypnotist was saying.”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“Învesmântate în acest sentiment al extazului, arzând de o adânca semnificatie divina si filozofica, viziunile lui Hildegard au contribuit la îndrumarea ei catre o viata închinata sfinteniei si misticismului. Sunt un exemplu unic pentru felul în care un eveniment fiziologic, banal, neplacut sau lipsit de sens pentru majoritatea oamenilor, poate deveni, Într-o constiinta privilegiata, substratul unei supreme inspiratii extatice. Pentru a gasi o paralela potrivita, trebuie sa ne întoarcem la Dostoievski, care traia uneori aure epileptice extatice carora le acorda o semnificatie importanta: Exista momente, care nu dureaza decât cinci sau sase secunde, când simti prezenta armoniei vesnice [...] un lucru formidabil e limpezimea teribila cu care se manifesta si încântarea de care te umplu. Daca aceasta stare ar tine mai mult de cinci secunde, sufletul n-ar putea-o îndura si ar trebui sa dispara. În decursul acestor cinci secunde traiesc o întreaga existenta omeneasca, iar pentru asta mi-as da viata fara sa-mi treaca prin minte ca platesc prea scump ...”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“The combination of mental and physical practice leads to greater performance improvement than does physical practice alone, a phenomenon for which our findings provide a physiological explanation. - Alvaro Pascual-Leone”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“What is more important for us, at an elemental level, than the control, the owning and operation, of our own physical selves? And yet it is so automatic, so familiar, we never give it a thought.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat: Picador Classic
“Empirical science, empiricism, takes no account of the soul, no account of what constitutes and determines personal being.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“My note was a strange mixture of facts and observations, carefully noted and itemised, with irrepressible meditations on what such problems might 'mean', in regard to who and what and where this poor man was - whether, indeed, one could speak of an 'existence', given so absolute a privation of memory or continuity.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Where was I? What had been done? I replied that I was in the recovery room and that he had detached the lateral rectus muscle of the right eye and attached the plaque containing radioiodine (I-125, to be precise) to the sclera. I said that I was sorry it was not radioactive ruthenium instead of iodine (I have a thing for the platinum metals) but that 125, at least, was memorable for being the smallest number that was the sum of two squares in two different ways. I startled myself as I said this; I had not thought it out before—it just jumped into my mind. (I realized, a few minutes later, that I was wrong—65 is the smallest such number.)”
― Oliver Sacks, The Mind's Eye
“Specifically, he wonders – and one in turn may wonder whether these thoughts were perhaps incited by his working with patients, in a hospital, in the war – he wonders whether there might be situations or conditions which take away the certainty of the body, which do give one grounds to doubt one’s body, perhaps indeed to lose one’s entire body in total doubt. This thought seems to haunt his last book like a nightmare.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat: Picador Classic
“Perhaps there is a philosophical as well as a clinical lesson here: that in Korsakov’s, or dementia, or other such catastrophes, however great the organic damage and Humean dissolution, there remains the undiminished possibility of reintegration by art, by communion, by touching the human spirit: and this can be preserved in what seems at first a hopeless state of neurological devastation.”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“67.What Jacob discovered in himself has similarities to a phenomenon reported in experimental animals by Arnaud Noreña and Jos Eggermont in 2005. They found that cats exposed to “noise trauma” and then raised for a few weeks in a quiet environment developed not only hearing loss but distorted tonotopic maps in the primary auditory cortex. (They would have complained of pitch distortion, were they able to.) If, however, the cats were exposed to an enriched acoustic environment for several weeks following exposure to noise trauma, their hearing loss was less severe, and distortions in their auditory cortical mapping did not occur.”
― Oliver Sacks, Musicophilia: Tales of Music and the Brain
“He was not imitating me; he had become me, in a sense; it was like suddenly acquiring a younger twin.”
― Oliver Sacks, On the Move: A Life
“As I demonstrated this on Bob, he fell backwards onto me, completely inert and passive, with no hint of any reflexive reaction. Startled, I pushed him gently forward to the upright position, but now he started to topple forward; I could not balance him. I had a sense of bewilderment mixed with panic. For a moment, I thought that there had suddenly been a neurological catastrophe, that he had actually lost all his postural reflexes. Could acting like this, I wondered, actually alter the nervous system? The next day I was talking with him in his dressing room before the day’s shooting began, and as we talked, I noticed that his right foot was turned in with precisely the dystonic curvature it was held in when he portrayed Leonard L. on the set. I commented on this, and Bob seemed rather startled. “I didn’t realize,” he said. “I guess it’s unconscious.” He sometimes stayed in character for hours or days; he would make comments at dinner which belonged to Leonard, not himself, as if residues of the Leonard mind and character were still adhering to him.”
― Oliver Sacks, On the Move: A Life
“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.”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“the delirious visions when they came to him may have owed something to opium as well as to a high temperature, since opium was then a normal remedy for ague or malaria.”
― Oliver Sacks, Hallucinations
“patients with aphasia and left-hemisphere lesions, says they have lost ‘abstract’ and ‘propositional’ thought—and compares them with dogs (or, rather, he compares dogs to patients with aphasia).”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“Lev Vygotsky, the great Russian psychologist, used to speak of “thinking in pure meanings.” I cannot decide whether this is nonsense or profound truth—it is the sort of reef I end up on when I think about thinking.”
― Oliver Sacks, The Mind's Eye
“Cualquier enfermedad introduce una duplicidad en la vida: un "ello", con sus propias necesidades, exigencias y limitaciones.”
― Oliver Sacks, An Anthropologist on Mars: Seven Paradoxical Tales
“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 those 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.
This is why they laughed at the President's speech.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“I stayed, as always, at 37 Mapesbury, and on publication day my father came into my bedroom, pale and shaking, holding The Times in his hands. He said, fearfully, “You’re in the papers.” There was a very nice essay-review in the paper which called Migraine “balanced, authoritative, brilliant,” or something of the sort. But so far as my father was concerned, this made no difference; I had committed a grave impropriety, if not a criminal folly, by being in the papers. In those days, one might be struck off the Medical Register in England for any indulgence in “the four As”: alcoholism, addiction, adultery, or advertising; my father thought that a review of Migraine in the general press might be seen as advertising. I had gone public, made myself visible. He himself always had, or believed he had, a “low profile.” He was known to and beloved by his patients, family, and friends, but not to a wider world. I had crossed a boundary, transgressed, and he feared for me. This coincided with feelings I had had myself, and in those days I often misread the word “publish” as “punish.” I felt that I would be punished if I published anything, and yet I had to; this conflict almost tore me apart.”
― Oliver Sacks, On the Move: A Life
“Rousseau habla de un lenguaje humano original o primordial, en el que todo tiene su nombre natural y auténtico; un lenguaje tan concreto, tan particular, que es capaz de captar la esencia, la mismidad de todo; tan espontáneo que expresa directamente todas las emociones; tan transparente que no caben en él evasivas ni engaños. En éste lenguaje no habría lógica ni gramática ni metáforas ni abstracciones (ni necesidad de ellas, en realidad); no sería un lenguaje meditado, una expresión simbólica del pensamiento y el sentimiento, sino sería, casi mágicamente, inmediato. Quizás sea una fantasía universal la idea de un lenguaje así, de un lenguaje del corazón, de un lenguaje de transparencia y lucidez perfectas, un lenguaje capaz de decirlo todo, sin engañarnos ni embrollarnos nunca, un lenguaje tan puro como la música.”
― Oliver Sacks, Seeing Voices
“None of us had ever encountered, or even imagined, such a power of amnesia, the possibility of a pit into which everything, every experience, every event, would fathomlessly drop, a bottomless memory-hole that would engulf the whole world.”
― Oliver Sacks
“He has achieved what Nietzsche liked to call ‘The Great Health’—rare humour, valour, and resilience of spirit: despite being, or because he is, afflicted with Tourette’s.”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“Ci ricordano che siamo sovrasviluppati in fatto di competenza meccanica, ma manchiamo di intelligenza, intuizione, consapevolezza biologiche; ed è questo, soprattutto, che dobbiamo riguadagnare, non solamente in medicina, ma nella scienza in generale.”
― Oliver Sacks, Risvegli
“I have traversed many kinds of health, and keep traversing them... and as for sickness: are we not almost tempted to ask whether we could get along without it? Only great pain is the liberator of the spirit.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“To restore the human subject at the centre - the suffering, afflicted, fighting, human subject - we must deepen a case history to a narrative or tale; only then do we have a 'who' as well as a 'what', a real person, a patient, in relation to disease - in relation to the physical.
The patient's essential being is very relevant in the higher reaches of neurology, and in psychology; for here the patient's personhood is essentially involved, and the study of disease and of identity cannot be disjoined.”
― Oliver Sacks
“Having ferned for an hour, we take a break for our lunch and I eat, unwisely, quite an enormous meal....”
― Oliver Sacks, Oaxaca Journal
“I sometimes wonder why I pushed myself so relentlessly in weight lifting. My motive, I think, was not an uncommon one; I was not the ninety-eight-pound weakling of bodybuilding advertisements, but I was timid, diffident, insecure, submissive. I became strong—very strong—with all my weight lifting but found that this did nothing for my character, which remained exactly the same.”
― Oliver Sacks, On the Move: A Life
“Increasingly now, week by week, the normal, unconscious feedback of proprioception was being replaced by an equally unconscious feedback by vision, by visual automatism and reflexes increasingly integrated and fluent.”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“Удивительное дело – она и победила, и проиграла. Восстановив действие, она утратила бытие. Пустив в ход все ресурсы нервной системы, а также волю, мужество, выдержку и независимость, она приспособилась к новой жизни. Столкнувшись с беспрецедентной ситуацией, она вступила в схватку со страшным врагом и выжила – огромным напряжением физических и духовных сил. Ее можно причислить к когорте безвестных героев неврологии. Но при этом она по-прежнему остается инвалидом и жертвой. Никакие высоты духа, никакая изобретательность, никакие адаптивные механизмы не могут справиться с абсолютным молчанием проприоцепции – жизненно важного шестого чувства, без которого наше тело утрачивает реальность, уходит от нас навсегда.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“physician. Though I no longer had a position or salary at Beth”
― Oliver Sacks, On the Move: A Life
“For 'wellness', naturally is no cause of complaint--people relish it, they enjoy it, they are at the furthest pole from complaint. People complain of feeling ill--not well. Unless, as George Eliot does, they have some intimation of 'wrongness' or danger, either through knowledge or association, or the very excess of excess. Thus, though a patient will scarcely complain of being 'very well', they may become suspicious if they feel 'too well'.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“Individuality is deeply imbued in us from the very start, at the neuronal level. Even at a motor level, researchers have shown, an infant does not follow a set pattern of learning to walk or how to reach for something. Each baby experiments with different ways of reaching for objects and over the course of several months discovers or selects his own motor solutions. When we try to envisage the neural basis of such individual learning, we might imagine a "population" of movements (and their neural correlates) being strengthened or pruned away by experience.
Similar considerations arise with regard to recover and rehabilitation after strokes and other injuries. There are no rules; there is no prescribed path of recovery; every patient must discover or create his own motor and perceptual patterns, his own solutions to the challenges that face him; and it is the function of a sensitive therapist to help him in this.
And in its broadest sense, neural Darwinism implies that we are destined, whether we wish it or not, to a life of particularity and self-development, to make our own individual paths through life.”
― Oliver Sacks, On the Move: A Life
“I do not know how much a propensity to addiction is “hardwired” or how much it depends on circumstances or state of mind. All I know is that I was hooked after that night with an amphetamine-soaked joint and was to remain hooked for the next four years. In the thrall of amphetamines, sleep was impossible, food was neglected, and everything was subordinated to the stimulation of the pleasure centers in my brain.”
― Oliver Sacks, On the Move: A Life
“PTSD seems to have an even higher prevalence and greater severity following violence or disaster that is man-made; natural disasters, "acts of God," seem somehow easier to accept. (...). This is the case with acute stress reactions, too: I see it often with my patients in hospital, who can show extraordinary courage and calmness in facing the most dreadful diseases but fly into a rage if a nurse is late with a bedpan or a medication. The amorality of nature is accepted, whether it takes the form of a monsoon, an elephant in musth, or a disease; but being subjected helplessly to the will of others is not, for human behavior always carries (or is felt to carry) a moral charge.”
― Oliver Sacks, Hallucinations
“Is there any reason, we must wonder, why particular songs (or scenes) are ‘selected’ by particular patients for reproduction in their hallucinatory seizures?”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“In the course of a short city-block this frantic old woman frenetically caricatured the features of forty or fifty passers-by, in a quick-fire sequence of kaleidoscopic imitations, each lasting a second or two, sometimes less, and the whole dizzying sequence scarcely more than two minutes.
And there were ludicrous imitations of the second and third order; for the people in the street, startled, outraged, bewildered by her imitations, took on these expressions in reaction to her; and those expressions, in turn, were re-reflected, re-directed, re-distorted, by the Touretter, causing a still greater degree of outrage and shock. This grotesque, involuntary resonance, or mutuality, by which everyone was drawn into an absurdly amplifying interaction, was the source of the disturbance I had seen from a distance. This woman who, becoming everybody, lost her own self, became nobody. This woman with a thousand faces, masks, personae- how must it be for her in this whirlwind of identities? The answer came soon- and not a second too late; for the build-up of pressures, both hers and others’, was fast approaching the point of explosion. Suddenly, desperately, the old woman turned aside, into an alley-way which led off the main street. And there, with all the appearances of a woman violently sick, she expelled, tremendously accelerated and abbreviated, all the gestures, the postures, the expressions, the demeanours, the entire behavioural repertoires, of the past forty or fifty people she had passed. She delivered one vast, pantomimic egurgitation, in which the engorged identities of the last fifty people who had possessed her were spewed out. And if the taking-in had lasted two minutes, the throwing-out was a single exhalation- fifty people in ten seconds, a fifth of a second or less for the time-foreshortened repertoire of each person.
I was later to spend hundreds of hours, talking to, observing, taping, learning from, Tourette patients. Yet nothing, I think, taught me as much, as swiftly, as penetratingly, as overwhelmingly as that phantasmagoric two minutes in a New York street.”
― Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales
“a ‘musical epilepsy’ or a ‘personal epilepsy’ would seem a contradiction in terms. And yet such epilepsies do occur, though solely in the context of temporal lobe seizures, epilepsies of the reminiscent part of the brain.”
― Oliver Sacks, The Man Who Mistook His Wife For A Hat: And Other Clinical Tales
“I felt inspired by Karl and determined to lift greater pound-ages myself, to work on the one lift I was already fairly good at—the squat. Training intensively, even obsessively, at a small gym in San Rafael, I worked up to doing five sets of five reps with 555 pounds every fifth day. The symmetry of this pleased me but caused amusement at the gym—“Sacks and his fives.” I didn’t realize how exceptional this was until another lifter encouraged me to have a go at the California squat record. I did so, diffidently, and to my delight was able to set a new record, a squat with a 600-pound bar on my shoulders. This was to serve as my introduction to the power-lifting world; a weight-lifting record”
― Oliver Sacks, On the Move: A Life
“There is no need,” he said, suddenly getting serious, “to get dead drunk, pass out, and lie in the gutter. This is a very sad—even dangerous—thing to do. I hope you will never do it again.”
― Oliver Sacks, On the Move: A Life
“Life must be lived forwards but can only be understood backwards.” —Kierkegaard”
― Oliver Sacks, On the Move: A Life
Hallucinations by Oliver Sacks
Have you ever seen something that wasn’t really there? Heard someone call your name in an empty house? Sensed someone following you and turned around to find nothing?
In this book, with his usual elegance, curiosity, and compassion, Dr Sacks weaves together stories of his patients and of his own mind-altering experiences to illuminate what hallucinations tell us about the organization and structure of our brains, how they have influenced every culture’s folklore and art, and why the potential for hallucination is present in us all, a vital part of the human condition.
The Man Who Mistook His Wife for a Hat by Oliver Sacks
Dr. Sacks treats each of his subjects—the amnesic fifty-year-old man who believes himself to be a young sailor in the Navy, the “disembodied” woman whose limbs have become alien to her, and of course the famous man who mistook his wife for a hat—with a deep respect for the unique individual living beneath the disorder. These tales inspire awe and empathy, allowing the reader to enter the uncanny worlds of those with autism, Alzheimer’s, Tourette’s syndrome, and other unfathomable neurological conditions. “One of the great clinical writers of the 20th century” (The New York Times), Dr. Sacks brings to vivid life some of the most fundamental questions about identity and the human mind.
The Man Who Mistook His Wife for a Hat by Oliver Sacks
Excerpt
Dr P. was a musician of distinction, well-known for many years as a singer, and then, at the local School of Music, as a teacher. It was here, in relation to his students, that certain strange problems were first observed. Sometimes a student would present himself, and Dr P. would not recognise him; or, specifically, would not recognise his face. The moment the student spoke, he would be recognised by his voice. Such incidents multiplied, causing embarrassment, perplexity, fear—and, sometimes, comedy. For not only did Dr P. increasingly fail to see faces, but he saw faces when there were no faces to see: genially, Magoo-like, when in the street he might pat the heads of water hydrants and parking meters, taking these to be the heads of children; he would amiably address carved knobs on the furniture and be astounded when they did not reply. At first these odd mistakes were laughed off as jokes, not least by Dr P. himself. Had he not always had a quirky sense of humour and been given to Zen-like paradoxes and jests? His musical powers were as dazzling as ever; he did not feel ill—he had never felt better; and the mistakes were so ludicrous—and so ingenious—that they could hardly be serious or betoken anything serious. The notion of there being ‘something the matter’ did not emerge until some three years later, when diabetes developed. Well aware that diabetes could affect his eyes, Dr P. consulted an ophthalmologist, who took a careful history and examined his eyes closely. ‘There’s nothing the matter with your eyes,’ the doctor concluded. ‘But there is trouble with the visual parts of your brain. You don’t need my help, you must see a neurologist.’ And so, as a result of this referral, Dr P. came to me.
It was obvious within a few seconds of meeting him that there was no trace of dementia in the ordinary sense. He was a man of great cultivation and charm who talked well and fluently, with imagination and humour. I couldn’t think why he had been referred to our clinic.
And yet there was something a bit odd. He faced me as he spoke, was oriented towards me, and yet there was something the matter—it was difficult to formulate. He faced me with his ears, I came to think, but not with his eyes. These, instead of looking, gazing, at me, ‘taking me in’, in the normal way, made sudden strange fixations—on my nose, on my right ear, down to my chin, up to my right eye—as if noting (even studying) these individual features, but not seeing my whole face, its changing expressions, ‘me’, as a whole. I am not sure that I fully realised this at the time—there was just a teasing strangeness, some failure in the normal interplay of gaze and expression. He saw me, he scanned me, and yet . . .
‘What seems to be the matter?’ I asked him at length.
‘Nothing that I know of,’ he replied with a smile, ‘but people seem to think there’s something wrong with my eyes.’
‘But you don’t recognise any visual problems?’
‘No, not directly, but I occasionally make mistakes.’
I left the room briefly to talk to his wife. When I came back, Dr P. was sitting placidly by the window, attentive, listening rather than looking out. ‘Traffic,’ he said, ‘street sounds, distant trains—they make a sort of symphony, do they not? You know Honegger’s Pacific 234?’
What a lovely man, I thought to myself. How can there be anything seriously the matter? Would he permit me to examine him?
‘Yes, of course, Dr Sacks.’
I stilled my disquiet, his perhaps, too, in the soothing routine of a neurological exam—muscle strength, coordination, reflexes, tone. . . . It was while examining his reflexes—a trifle abnormal on the left side—that the first bizarre experience occurred. I had taken off his left shoe and scratched the sole of his foot with a key—a frivolous-seeming but essential test of a reflex—and then, excusing myself to screw my ophthalmoscope together, left him to put on the shoe himself. To my surprise, a minute later, he had not done this.
‘Can I help?’ I asked.
‘Help what? Help whom?’
‘Help you put on your shoe.’
‘Ach,’ he said, ‘I had forgotten the shoe,’ adding, sotto voce, ‘The shoe? The shoe?’ He seemed baffled.
‘Your shoe,’ I repeated. ‘Perhaps you’d put it on.’
He continued to look downwards, though not at the shoe, with an intense but misplaced concentration. Finally his gaze settled on his foot: ‘That is my shoe, yes?’
Did I mis-hear? Did he mis-see?
‘My eyes,’ he explained, and put a hand to his foot. ‘This is my shoe, no?’
‘No, it is not. That is your foot. There is your shoe.’
‘Ah! I thought that was my foot.’
Was he joking? Was he mad? Was he blind? If this was one of his ‘strange mistakes’, it was the strangest mistake I had ever come across.
I helped him on with his shoe (his foot), to avoid further complication. Dr P. himself seemed untroubled, indifferent, maybe amused. I resumed my examination. His visual acuity was good: he had no difficulty seeing a pin on the floor, though sometimes he missed it if it was placed to his left.
He saw all right, but what did he see? I opened out a copy of the National Geographic Magazine and asked him to describe some pictures in it.
His responses here were very curious. His eyes would dart from one thing to another, picking up tiny features, individual features, as they had done with my face. A striking brightness, a colour, a shape would arrest his attention and elicit comment—but in no case did he get the scene-as-a-whole. He failed to see the whole, seeing only details, which he spotted like blips on a radar screen. He never entered into relation with the picture as a whole—never faced, so to speak, its physiognomy. He had no sense whatever of a landscape or scene.
I showed him the cover, an unbroken expanse of Sahara dunes.
‘What do you see here?’ I asked.
‘I see a river,’ he said. ‘And a little guest-house with its terrace on the water. People are dining out on the terrace. I see coloured parasols here and there.’ He was looking, if it was ‘looking’, right off the cover into mid-air and confabulating nonexistent features, as if the absence of features in the actual picture had driven him to imagine the river and the terrace and the coloured parasols.
I must have looked aghast, but he seemed to think he had done rather well. There was a hint of a smile on his face. He 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.
I could make no sense of what had occurred in terms of conventional neurology (or neuropsychology). In some ways he seemed perfectly preserved, and in others absolutely, incomprehensibly devastated. How could he, on the one hand, mistake his wife for a hat and, on the other, function, as apparently he still did, as a teacher at the Music School?
I had to think, to see him again—and to see him in his own familiar habitat, at home.
A few days later I called on Dr P. and his wife at home, with the score of the Dichterliebe in my briefcase (I knew he liked Schumann), and a variety of odd objects for the testing of perception. Mrs P. showed me into a lofty apartment, which recalled fin-de-siècle Berlin. A magnificent old Bösendorfer stood in state in the centre of the room, and all around it were music stands, instruments, scores. . . . There were books, there were paintings, but the music was central. Dr P. came in, a little bowed, and, distracted, advanced with outstretched hand to the grandfather clock, but, hearing my voice, corrected himself, and shook hands with me. We exchanged greetings and chatted a little of current concerts and performances. Diffidently, I asked him if he would sing.
‘The Dichterliebe!’ he exclaimed. ‘But I can no longer read music. You will play them, yes?’
I said I would try. On that wonderful old piano even my playing sounded right, and Dr P. was an aged but infinitely mellow Fischer-Dieskau, combining a perfect ear and voice with the most incisive musical intelligence. It was clear that the Music School was not keeping him on out of charity.
Dr P.’s temporal lobes were obviously intact: he had a wonderful musical cortex. What, I wondered, was going on in his parietal and occipital lobes, especially in those areas where visual processing occurred? I carry the Platonic solids in my neurological kit and decided to start with these.
‘What is this?’ I asked, drawing out the first one.
‘A cube, of course.’
‘Now this?’ I asked, brandishing another.
He asked if he might examine it, which he did swiftly and systematically: ‘A dodecahedron, of course. And don’t bother with the others—I’ll get the icosahedron, too.’
Abstract shapes clearly presented no problems. What about faces? I took out a pack of cards. All of these he identified instantly, including the jacks, queens, kings, and the joker. But these, after all, are stylised designs, and it was impossible to tell whether he saw faces or merely patterns. I decided I would show him a volume of cartoons which I had in my briefcase. Here, again, for the most part, he did well. Churchill’s cigar, Schnozzle’s nose: as soon as he had picked out a key feature he could identify the face. But cartoons, again, are formal and schematic. It remained to be seen how he would do with real faces, realistically represented.
I turned on the television, keeping the sound off, and found an early Bette Davis film. A love scene was in progress. Dr P. failed to identify the actress—but this could have been because she had never entered his world. What was more striking was that he failed to identify the expressions on her face or her partner’s, though in the course of a single torrid scene these passed from sultry yearning through passion, surprise, disgust, and fury to a melting reconciliation. Dr P. could make nothing of any of this. He was very unclear as to what was going on, or who was who or even what sex they were. His comments on the scene were positively Martian.
It was just possible that some of his difficulties were associated with the unreality of a celluloid, Hollywood world; and it occurred to me that he might be more successful in identifying faces from his own life. On the walls of the apartment there were photographs of his family, his colleagues, his pupils, himself. I gathered a pile of these together and, with some misgivings, presented them to him. What had been funny, or farcical, in relation to the movie, was tragic in relation to real life. By and large, he recognised nobody: neither his family, nor his colleagues, nor his pupils, nor himself. He recognised a portrait of Einstein because he picked up the characteristic hair and moustache; and the same thing happened with one or two other people. ‘Ach, Paul!’ he said, when shown a portrait of his brother. ‘That square jaw, those big teeth—I would know Paul anywhere!’ But was it Paul he recognised, or one or two of his features, on the basis of which he could make a reasonable guess as to the subject’s identity? In the absence of obvious ‘markers’, he was utterly lost. But it was not merely the cognition, the gnosis, at fault; there was something radically wrong with the whole way he proceeded. For he approached these faces—even of those near and dear—as if they were abstract puzzles or tests. He did not relate to them, he did not behold. No face was familiar to him, seen as a ‘thou’, being just identified as a set of features, an ‘it’. Thus, there was formal, but no trace of personal, gnosis. And with this went his indifference, or blindness, to expression. A face, to us, is a person looking out—we see, as it were, the person through his persona, his face. But for Dr P. there was no persona in this sense—no outward persona, and no person within.
I had stopped at a florist on my way to his apartment and bought myself an extravagant red rose for my buttonhole. Now I removed this and handed it to him. He took it like a botanist or morphologist given a specimen, not like a person given a flower.
‘About six inches in length,’ he commented. ‘A convoluted red form with a linear green attachment.’
‘Yes,’ I said encouragingly, ‘and what do you think it is, Dr P.?’
‘Not easy to say.’ He seemed perplexed. ‘It lacks the simple symmetry of the Platonic solids, although it may have a higher symmetry of its own. . . . I think this could be an inflorescence or flower.’
‘Could be?’ I queried.
‘Could be,’ he confirmed.
‘Smell it,’ I suggested, and he again looked somewhat puzzled, as if I had asked him to smell a higher symmetry. But he complied courteously, and took it to his nose. Now, suddenly, he came to life.
‘Beautiful!’ he exclaimed. ‘An early rose. What a heavenly smell!’ He started to hum ‘Die Rose, die Lillie . . .’ Reality, it seemed, might be conveyed by smell, not by sight.
I tried one final test. It was still a cold day, in early spring, and I had thrown my coat and gloves on the sofa.
‘What is this?’ I asked, holding up a glove.
‘May I examine it?’ he asked, and, taking it from me, he proceeded to examine it as he had examined the geometrical shapes.
‘A continuous surface,’ he announced at last, ‘infolded on itself. It appears to have’—he hesitated—‘five outpouchings, if this is the word.’
‘Yes,’ I said cautiously. ‘You have given me a description. Now tell me what it is.’
‘A container of some sort?’
‘Yes,’ I said, ‘and what would it contain?’
‘It would contain its contents!’ said Dr P., with a laugh. ‘There are many possibilities. It could be a change purse, for example, for coins of five sizes. It could . . .’
I interrupted the barmy flow. ‘Does it not look familiar? Do you think it might contain, might fit, a part of your body?’
No light of recognition dawned on his face. (Later, by accident, he got it on, and exclaimed, ‘My God, it’s a glove!’ This was reminiscent of Kurt Goldstein’s patient ‘Lanuti’, who could only recognise objects by trying to use them in action.)
No child would have the power to see and speak of ‘a continuous surface . . . infolded on itself,’ but any child, any infant, would immediately know a glove as a glove, see it as familiar, as going with a hand. Dr P. didn’t. He saw nothing as familiar. Visually, he was lost in a world of lifeless abstractions. Indeed, he did not have a real visual world, as he did not have a real visual self. He could speak about things, but did not see them face-to-face. Hughlings Jackson, discussing patients with aphasia and left-hemisphere lesions, says they have lost ‘abstract’ and ‘propositional’ thought—and compares them with dogs (or, rather, he compares dogs to patients with aphasia). Dr P., on the other hand, functioned precisely as a machine functions. It wasn’t merely that he displayed the same indifference to the visual world as a computer but—even more strikingly—he construed the world as a computer construes it, by means of key features and schematic relationships. The scheme might be identified—in an ‘identi-kit’ way—without the reality being grasped at all.
The testing I had done so far told me nothing about Dr P.’s inner world. Was it possible that his visual memory and imagination were still intact? I asked him to imagine entering one of our local squares from the north side, to walk through it, in imagination or in memory, and tell me the buildings he might pass as he walked. He listed the buildings on his right side, but none of those on his left. I then asked him to imagine entering the square from the south. Again he mentioned only those buildings that were on the right side, although these were the very buildings he had omitted before. Those he had ‘seen’ internally before were not mentioned now; presumably, they were no longer ‘seen’. It was evident that his difficulties with leftness, his visual field deficits, were as much internal as external, bisecting his visual memory and imagination.
What, at a higher level, of his internal visualisation? Thinking of the almost hallucinatory intensity with which Tolstoy visualises and animates his characters, I questioned Dr P. about Anna Karenina. He could remember incidents without difficulty, had an undiminished grasp of the plot, but completely omitted visual characteristics, visual narrative, and scenes. He remembered the words of the characters but not their faces; and though, when asked, he could quote, with his remarkable and almost verbatim memory, the original visual descriptions, these were, it became apparent, quite empty for him and lacked sensorial, imaginal, or emotional reality. Thus, there was an internal agnosia as well. (I have often wondered about Helen Keller’s visual descriptions, whether these, for all their eloquence, are somehow empty as well? Or whether, by the transference of images from the tactile to the visual, or, yet more extraordinarily, from the verbal and the metaphorical to the sensorial and the visual, she did achieve a power of visual imagery, even though her visual cortex had never been stimulated, directly, by the eyes? 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 pictorially—the ‘message’ of the dream being conveyed in nonvisual terms.)
But this was only the case, it became clear, with certain sorts of visualisation. The visualisation of faces and scenes, of visual narrative and drama—this was profoundly impaired, almost absent. But the visualisation of schemata was preserved, perhaps enhanced. Thus, when I engaged him in a game of mental chess, he had no difficulty visualising the chessboard or the moves—indeed, no difficulty in beating me soundly.
Luria said of Zazetsky that he had entirely lost his capacity to play games but that his ‘vivid imagination’ was unimpaired. Zazetsky and Dr P. lived in worlds which were mirror images of each other. But the saddest difference between them was that Zazetsky, as Luria said, ‘fought to regain his lost faculties with the indomitable tenacity of the damned,’ whereas Dr P. was not fighting, did not know what was lost, did not indeed know that anything was lost. But who was more tragic, or who was more damned—the man who knew it, or the man who did not?
When the examination was over, Mrs P. called us to the table, where there was coffee and a delicious spread of little cakes. Hungrily, hummingly, Dr P. started on the cakes. Swiftly, fluently, unthinkingly, melodiously, he pulled the plates towards him and took this and that in a great gurgling stream, an edible song of food, until, suddenly, there came an interruption: a loud, peremptory rat-tat-tat at the door. Startled, taken aback, arrested by the interruption, Dr P. stopped eating and sat frozen, motionless, at the table, with an indifferent, blind bewilderment on his face. He saw, but no longer saw, the table; no longer perceived it as a table laden with cakes. His wife poured him some coffee: the smell titillated his nose and brought him back to reality. The melody of eating resumed.
How does he do anything? I wondered to myself. What happens when he’s dressing, goes to the lavatory, has a bath? I followed his wife into the kitchen and asked her how, for instance, he managed to dress himself. ‘It’s just like the eating,’ she explained. ‘I put his usual clothes out, in all the usual places, and he dresses without difficulty, singing to himself. He does everything singing to himself. But if he is interrupted and loses the thread, he comes to a complete stop, doesn’t know his clothes—or his own body. He sings all the time—eating songs, dressing songs, bathing songs, everything. He can’t do anything unless he makes it a song.’
While we were talking my attention was caught by the pictures on the walls.
‘Yes,’ Mrs P. said, ‘he was a gifted painter as well as a singer. The School exhibited his pictures every year.’
I strolled past them curiously—they were in chronological order. All his earlier work was naturalistic and realistic, with vivid mood and atmosphere, but finely detailed and concrete. Then, years later, they became less vivid, less concrete, less realistic and naturalistic, but far more abstract, even geometrical and cubist. Finally, in the last paintings, the canvasses became nonsense, or nonsense to me—mere chaotic lines and blotches of paint. I commented on this to Mrs P.
‘Ach, you doctors, you’re such Philistines!’ she exclaimed. ‘Can you not see artistic development—how he renounced the realism of his earlier years, and advanced into abstract, nonrepresentational art?’
‘No, that’s not it,’ I said to myself (but forbore to say it to poor Mrs P.). He had indeed moved from realism to nonrepresentation to the abstract, yet this was not the artist, but the pathology, advancing—advancing towards a profound visual agnosia, in which all powers of representation and imagery, all sense of the concrete, all sense of reality, were being destroyed. This wall of paintings was a tragic pathological exhibit, which belonged to neurology, not art.
And yet, I wondered, was she not partly right? For there is often a struggle, and sometimes, even more interestingly, a collusion between the powers of pathology and creation. Perhaps, in his cubist period, there might have been both artistic and pathological development, colluding to engender an original form; for as he lost the concrete, so he might have gained in the abstract, developing a greater sensitivity to all the structural elements of line, boundary, contour—an almost Picasso-like power to see, and equally depict, those abstract organisations embedded in, and normally lost in, the concrete. . . . Though in the final pictures, I feared, there was only chaos and agnosia.
We returned to the great music room, with the Bösendorfer in the centre, and Dr P. humming the last torte.
‘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?’
‘I 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 centre, now make it the whole, of your life.’
This was four years ago—I never saw him again, but I often wondered about how he apprehended the world, given his strange loss of image, visuality, and the perfect preservation of a great musicality. I think that music, for him, had taken the place of image. He had no body-image, he had body-music: this is why he could move and act as fluently as he did, but came to a total confused stop if the ‘inner music’ stopped. And equally with the outside, the world . . . (Thus, as I learned later from his wife, though he could not recognise his students if they sat still, if they were merely ‘images’, he might suddenly recognise them if they moved. ‘That’s Karl,’ he would cry. ‘I know his movements, his body-music’)
In The World as Representation and Will, Schopenhauer speaks of music as ‘pure will’. How fascinated he would have been by Dr P., a man who had wholly lost the world as representation, but wholly preserved it as music or will.
And this, mercifully, held to the end—for despite the gradual advance of his disease (a massive tumour or degenerative process in the visual parts of his brain) Dr P. lived and taught music to the last days of his life.
These explanations, or modes of explanation, are not mutually exclusive—being in different modes they could coexist and both be true. And this is acknowledged, implicitly or explicitly, in classical neurology: implicitly, by Macrae, when he finds the explanation of defective schemata, or defective visual processing and integration, inadequate; explicitly, by Goldstein, when he speaks of ‘abstract attitude’. But abstract attitude, which allows ‘categorisation’, also misses the mark with Dr P.—and, perhaps, with the concept of ‘judgment’ in general. For Dr P. had abstract attitude—indeed, nothing else. And it was precisely this, his absurd abstractness of attitude—absurd because unleavened with anything else—which rendered him incapable of perceiving identity, or particulars, rendered him incapable of judgment.
Neurology and psychology, curiously, though they talk of everything else, almost never talk of ‘judgment’—and yet it is precisely the downfall of judgment (whether in specific realms, as with Dr P., or more generally, as in patients with Korsakov’s or frontal-lobe syndromes—see below, Chapters Twelve and Thirteen) which constitutes the essence of so many neuropsychological disorders. Judgment and identity may be casualties—but neuropsychology never speaks of them.
And yet, whether in a philosophic sense (Kant’s sense), or an empirical and evolutionary sense, judgment is the most important faculty we have. An animal, or a man, may get on very well without ‘abstract attitude’ but will speedily perish if deprived of judgment. Judgment must be the first faculty of higher life or mind—yet it is ignored, or misinterpreted, by classical (computational) neurology. And if we wonder how such an absurdity can arise, we find it in the assumptions, or the evolution, of neurology itself. For classical neurology (like classical physics) has always been mechanical—from Hughlings Jackson’s mechanical analogies to the computer analogies of today.
Of course, the brain is a machine and a computer—everything in classical neurology is correct. But our mental processes, which constitute our being and life, are not just abstract and mechanical, but personal, as well—and, as such, involve not just classifying and categorising, but continual judging and feeling also. If this is missing, we become computer-like, as Dr P. was. And, by the same token, if we delete feeling and judging, the personal, from the cognitive sciences, we reduce them to something as defective as Dr P.—and we reduce our apprehension of the concrete and real.
By a sort of comic and awful analogy, our current cognitive neurology and psychology resemble nothing so much as poor Dr P.! We need the concrete and real, as he did; and we fail to see this, as he failed to see it. Our cognitive sciences are themselves suffering from an agnosia essentially similar to Dr P.’s. Dr P. may therefore serve as a warning and parable—of what happens to a science which eschews the judgmental, the particular, the personal, and becomes entirely abstract and computational.
It was always a matter of great regret to me that, owing to circumstances beyond my control, I was not able to follow his case further, either in the sort of observations and investigations described, or in ascertaining the actual disease pathology.
Their patient was a young man of 32, who, following a severe automobile accident, with unconsciousness for three weeks, . . . complained, exclusively, of an inability to recognise faces, even those of his wife and children’. Not a single face was ‘familiar’ to him, but there were three he could identify; these were workmates: one with an eye-blinking tic, one with a large mole on his cheek, and a third ‘because he was so tall and thin that no one else was like him’. Each of these, Macrae and Trolle bring out, was ‘recognised solely by the single prominent feature mentioned’. In general (like Dr P.) he recognised familiars only by their voices.
He had difficulty even recognising himself in a mirror, as Macrae and Trolle describe in detail: ‘In the early convalescent phase he frequently, especially when shaving, questioned whether the face gazing at him was really his own, and even though he knew it could physically be none other, on several occasions grimaced or stuck out his tongue “just to make sure.” By carefully studying his face in the mirror he slowly began to recognise it, but “not in a flash” as in the past—he relied on the hair and facial outline, and on two small moles on his left cheek.’
In general he could not recognise objects ‘at a glance’, but would have to seek out, and guess from, one or two features—occasionally his guesses were absurdly wrong. In particular, the authors note, there was difficulty with the animate.
On the other hand, simple schematic objects—scissors, watch, key, etc.—presented no difficulties. Macrae and Trolle also note that: ‘His topographical memory was strange: the seeming paradox existed that he could find his way from home to hospital and around the hospital, but yet could not name streets en route [unlike Dr P., he also had some aphasia] or appear to visualize the topography.’
It was also evident that visual memories of people, even from long before the accident, were severely impaired—there was memory of conduct, or perhaps a mannerism, but not of visual appearance or face. Similarly, it appeared, when he was questioned closely, that he no longer had visual images in his dreams. Thus, as with Dr P., it was not just visual perception, but visual imagination and memory, the fundamental powers of visual representation, which were essentially damaged in this patient—at least those powers insofar as they pertained to the personal, the familiar, the concrete.
A final, humorous point. Where Dr P. might mistake his wife for a hat, Macrae’s patient, also unable to recognise his wife, needed her to identify herself by a visual marker, by ‘. . . a conspicuous article of clothing, such as a large hat’.
It was obvious within a few seconds of meeting him that there was no trace of dementia in the ordinary sense. He was a man of great cultivation and charm who talked well and fluently, with imagination and humour. I couldn’t think why he had been referred to our clinic.
And yet there was something a bit odd. He faced me as he spoke, was oriented towards me, and yet there was something the matter—it was difficult to formulate. He faced me with his ears, I came to think, but not with his eyes. These, instead of looking, gazing, at me, ‘taking me in’, in the normal way, made sudden strange fixations—on my nose, on my right ear, down to my chin, up to my right eye—as if noting (even studying) these individual features, but not seeing my whole face, its changing expressions, ‘me’, as a whole. I am not sure that I fully realised this at the time—there was just a teasing strangeness, some failure in the normal interplay of gaze and expression. He saw me, he scanned me, and yet . . .
‘What seems to be the matter?’ I asked him at length.
‘Nothing that I know of,’ he replied with a smile, ‘but people seem to think there’s something wrong with my eyes.’
‘But you don’t recognise any visual problems?’
‘No, not directly, but I occasionally make mistakes.’
I left the room briefly to talk to his wife. When I came back, Dr P. was sitting placidly by the window, attentive, listening rather than looking out. ‘Traffic,’ he said, ‘street sounds, distant trains—they make a sort of symphony, do they not? You know Honegger’s Pacific 234?’
What a lovely man, I thought to myself. How can there be anything seriously the matter? Would he permit me to examine him?
‘Yes, of course, Dr Sacks.’
I stilled my disquiet, his perhaps, too, in the soothing routine of a neurological exam—muscle strength, coordination, reflexes, tone. . . . It was while examining his reflexes—a trifle abnormal on the left side—that the first bizarre experience occurred. I had taken off his left shoe and scratched the sole of his foot with a key—a frivolous-seeming but essential test of a reflex—and then, excusing myself to screw my ophthalmoscope together, left him to put on the shoe himself. To my surprise, a minute later, he had not done this.
‘Can I help?’ I asked.
‘Help what? Help whom?’
‘Help you put on your shoe.’
‘Ach,’ he said, ‘I had forgotten the shoe,’ adding, sotto voce, ‘The shoe? The shoe?’ He seemed baffled.
‘Your shoe,’ I repeated. ‘Perhaps you’d put it on.’
He continued to look downwards, though not at the shoe, with an intense but misplaced concentration. Finally his gaze settled on his foot: ‘That is my shoe, yes?’
Did I mis-hear? Did he mis-see?
‘My eyes,’ he explained, and put a hand to his foot. ‘This is my shoe, no?’
‘No, it is not. That is your foot. There is your shoe.’
‘Ah! I thought that was my foot.’
Was he joking? Was he mad? Was he blind? If this was one of his ‘strange mistakes’, it was the strangest mistake I had ever come across.
I helped him on with his shoe (his foot), to avoid further complication. Dr P. himself seemed untroubled, indifferent, maybe amused. I resumed my examination. His visual acuity was good: he had no difficulty seeing a pin on the floor, though sometimes he missed it if it was placed to his left.
He saw all right, but what did he see? I opened out a copy of the National Geographic Magazine and asked him to describe some pictures in it.
His responses here were very curious. His eyes would dart from one thing to another, picking up tiny features, individual features, as they had done with my face. A striking brightness, a colour, a shape would arrest his attention and elicit comment—but in no case did he get the scene-as-a-whole. He failed to see the whole, seeing only details, which he spotted like blips on a radar screen. He never entered into relation with the picture as a whole—never faced, so to speak, its physiognomy. He had no sense whatever of a landscape or scene.
I showed him the cover, an unbroken expanse of Sahara dunes.
‘What do you see here?’ I asked.
‘I see a river,’ he said. ‘And a little guest-house with its terrace on the water. People are dining out on the terrace. I see coloured parasols here and there.’ He was looking, if it was ‘looking’, right off the cover into mid-air and confabulating nonexistent features, as if the absence of features in the actual picture had driven him to imagine the river and the terrace and the coloured parasols.
I must have looked aghast, but he seemed to think he had done rather well. There was a hint of a smile on his face. He 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.
I could make no sense of what had occurred in terms of conventional neurology (or neuropsychology). In some ways he seemed perfectly preserved, and in others absolutely, incomprehensibly devastated. How could he, on the one hand, mistake his wife for a hat and, on the other, function, as apparently he still did, as a teacher at the Music School?
I had to think, to see him again—and to see him in his own familiar habitat, at home.
A few days later I called on Dr P. and his wife at home, with the score of the Dichterliebe in my briefcase (I knew he liked Schumann), and a variety of odd objects for the testing of perception. Mrs P. showed me into a lofty apartment, which recalled fin-de-siècle Berlin. A magnificent old Bösendorfer stood in state in the centre of the room, and all around it were music stands, instruments, scores. . . . There were books, there were paintings, but the music was central. Dr P. came in, a little bowed, and, distracted, advanced with outstretched hand to the grandfather clock, but, hearing my voice, corrected himself, and shook hands with me. We exchanged greetings and chatted a little of current concerts and performances. Diffidently, I asked him if he would sing.
‘The Dichterliebe!’ he exclaimed. ‘But I can no longer read music. You will play them, yes?’
I said I would try. On that wonderful old piano even my playing sounded right, and Dr P. was an aged but infinitely mellow Fischer-Dieskau, combining a perfect ear and voice with the most incisive musical intelligence. It was clear that the Music School was not keeping him on out of charity.
Dr P.’s temporal lobes were obviously intact: he had a wonderful musical cortex. What, I wondered, was going on in his parietal and occipital lobes, especially in those areas where visual processing occurred? I carry the Platonic solids in my neurological kit and decided to start with these.
‘What is this?’ I asked, drawing out the first one.
‘A cube, of course.’
‘Now this?’ I asked, brandishing another.
He asked if he might examine it, which he did swiftly and systematically: ‘A dodecahedron, of course. And don’t bother with the others—I’ll get the icosahedron, too.’
Abstract shapes clearly presented no problems. What about faces? I took out a pack of cards. All of these he identified instantly, including the jacks, queens, kings, and the joker. But these, after all, are stylised designs, and it was impossible to tell whether he saw faces or merely patterns. I decided I would show him a volume of cartoons which I had in my briefcase. Here, again, for the most part, he did well. Churchill’s cigar, Schnozzle’s nose: as soon as he had picked out a key feature he could identify the face. But cartoons, again, are formal and schematic. It remained to be seen how he would do with real faces, realistically represented.
I turned on the television, keeping the sound off, and found an early Bette Davis film. A love scene was in progress. Dr P. failed to identify the actress—but this could have been because she had never entered his world. What was more striking was that he failed to identify the expressions on her face or her partner’s, though in the course of a single torrid scene these passed from sultry yearning through passion, surprise, disgust, and fury to a melting reconciliation. Dr P. could make nothing of any of this. He was very unclear as to what was going on, or who was who or even what sex they were. His comments on the scene were positively Martian.
It was just possible that some of his difficulties were associated with the unreality of a celluloid, Hollywood world; and it occurred to me that he might be more successful in identifying faces from his own life. On the walls of the apartment there were photographs of his family, his colleagues, his pupils, himself. I gathered a pile of these together and, with some misgivings, presented them to him. What had been funny, or farcical, in relation to the movie, was tragic in relation to real life. By and large, he recognised nobody: neither his family, nor his colleagues, nor his pupils, nor himself. He recognised a portrait of Einstein because he picked up the characteristic hair and moustache; and the same thing happened with one or two other people. ‘Ach, Paul!’ he said, when shown a portrait of his brother. ‘That square jaw, those big teeth—I would know Paul anywhere!’ But was it Paul he recognised, or one or two of his features, on the basis of which he could make a reasonable guess as to the subject’s identity? In the absence of obvious ‘markers’, he was utterly lost. But it was not merely the cognition, the gnosis, at fault; there was something radically wrong with the whole way he proceeded. For he approached these faces—even of those near and dear—as if they were abstract puzzles or tests. He did not relate to them, he did not behold. No face was familiar to him, seen as a ‘thou’, being just identified as a set of features, an ‘it’. Thus, there was formal, but no trace of personal, gnosis. And with this went his indifference, or blindness, to expression. A face, to us, is a person looking out—we see, as it were, the person through his persona, his face. But for Dr P. there was no persona in this sense—no outward persona, and no person within.
I had stopped at a florist on my way to his apartment and bought myself an extravagant red rose for my buttonhole. Now I removed this and handed it to him. He took it like a botanist or morphologist given a specimen, not like a person given a flower.
‘About six inches in length,’ he commented. ‘A convoluted red form with a linear green attachment.’
‘Yes,’ I said encouragingly, ‘and what do you think it is, Dr P.?’
‘Not easy to say.’ He seemed perplexed. ‘It lacks the simple symmetry of the Platonic solids, although it may have a higher symmetry of its own. . . . I think this could be an inflorescence or flower.’
‘Could be?’ I queried.
‘Could be,’ he confirmed.
‘Smell it,’ I suggested, and he again looked somewhat puzzled, as if I had asked him to smell a higher symmetry. But he complied courteously, and took it to his nose. Now, suddenly, he came to life.
‘Beautiful!’ he exclaimed. ‘An early rose. What a heavenly smell!’ He started to hum ‘Die Rose, die Lillie . . .’ Reality, it seemed, might be conveyed by smell, not by sight.
I tried one final test. It was still a cold day, in early spring, and I had thrown my coat and gloves on the sofa.
‘What is this?’ I asked, holding up a glove.
‘May I examine it?’ he asked, and, taking it from me, he proceeded to examine it as he had examined the geometrical shapes.
‘A continuous surface,’ he announced at last, ‘infolded on itself. It appears to have’—he hesitated—‘five outpouchings, if this is the word.’
‘Yes,’ I said cautiously. ‘You have given me a description. Now tell me what it is.’
‘A container of some sort?’
‘Yes,’ I said, ‘and what would it contain?’
‘It would contain its contents!’ said Dr P., with a laugh. ‘There are many possibilities. It could be a change purse, for example, for coins of five sizes. It could . . .’
I interrupted the barmy flow. ‘Does it not look familiar? Do you think it might contain, might fit, a part of your body?’
No light of recognition dawned on his face. (Later, by accident, he got it on, and exclaimed, ‘My God, it’s a glove!’ This was reminiscent of Kurt Goldstein’s patient ‘Lanuti’, who could only recognise objects by trying to use them in action.)
No child would have the power to see and speak of ‘a continuous surface . . . infolded on itself,’ but any child, any infant, would immediately know a glove as a glove, see it as familiar, as going with a hand. Dr P. didn’t. He saw nothing as familiar. Visually, he was lost in a world of lifeless abstractions. Indeed, he did not have a real visual world, as he did not have a real visual self. He could speak about things, but did not see them face-to-face. Hughlings Jackson, discussing patients with aphasia and left-hemisphere lesions, says they have lost ‘abstract’ and ‘propositional’ thought—and compares them with dogs (or, rather, he compares dogs to patients with aphasia). Dr P., on the other hand, functioned precisely as a machine functions. It wasn’t merely that he displayed the same indifference to the visual world as a computer but—even more strikingly—he construed the world as a computer construes it, by means of key features and schematic relationships. The scheme might be identified—in an ‘identi-kit’ way—without the reality being grasped at all.
The testing I had done so far told me nothing about Dr P.’s inner world. Was it possible that his visual memory and imagination were still intact? I asked him to imagine entering one of our local squares from the north side, to walk through it, in imagination or in memory, and tell me the buildings he might pass as he walked. He listed the buildings on his right side, but none of those on his left. I then asked him to imagine entering the square from the south. Again he mentioned only those buildings that were on the right side, although these were the very buildings he had omitted before. Those he had ‘seen’ internally before were not mentioned now; presumably, they were no longer ‘seen’. It was evident that his difficulties with leftness, his visual field deficits, were as much internal as external, bisecting his visual memory and imagination.
What, at a higher level, of his internal visualisation? Thinking of the almost hallucinatory intensity with which Tolstoy visualises and animates his characters, I questioned Dr P. about Anna Karenina. He could remember incidents without difficulty, had an undiminished grasp of the plot, but completely omitted visual characteristics, visual narrative, and scenes. He remembered the words of the characters but not their faces; and though, when asked, he could quote, with his remarkable and almost verbatim memory, the original visual descriptions, these were, it became apparent, quite empty for him and lacked sensorial, imaginal, or emotional reality. Thus, there was an internal agnosia as well. (I have often wondered about Helen Keller’s visual descriptions, whether these, for all their eloquence, are somehow empty as well? Or whether, by the transference of images from the tactile to the visual, or, yet more extraordinarily, from the verbal and the metaphorical to the sensorial and the visual, she did achieve a power of visual imagery, even though her visual cortex had never been stimulated, directly, by the eyes? 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 pictorially—the ‘message’ of the dream being conveyed in nonvisual terms.)
But this was only the case, it became clear, with certain sorts of visualisation. The visualisation of faces and scenes, of visual narrative and drama—this was profoundly impaired, almost absent. But the visualisation of schemata was preserved, perhaps enhanced. Thus, when I engaged him in a game of mental chess, he had no difficulty visualising the chessboard or the moves—indeed, no difficulty in beating me soundly.
Luria said of Zazetsky that he had entirely lost his capacity to play games but that his ‘vivid imagination’ was unimpaired. Zazetsky and Dr P. lived in worlds which were mirror images of each other. But the saddest difference between them was that Zazetsky, as Luria said, ‘fought to regain his lost faculties with the indomitable tenacity of the damned,’ whereas Dr P. was not fighting, did not know what was lost, did not indeed know that anything was lost. But who was more tragic, or who was more damned—the man who knew it, or the man who did not?
When the examination was over, Mrs P. called us to the table, where there was coffee and a delicious spread of little cakes. Hungrily, hummingly, Dr P. started on the cakes. Swiftly, fluently, unthinkingly, melodiously, he pulled the plates towards him and took this and that in a great gurgling stream, an edible song of food, until, suddenly, there came an interruption: a loud, peremptory rat-tat-tat at the door. Startled, taken aback, arrested by the interruption, Dr P. stopped eating and sat frozen, motionless, at the table, with an indifferent, blind bewilderment on his face. He saw, but no longer saw, the table; no longer perceived it as a table laden with cakes. His wife poured him some coffee: the smell titillated his nose and brought him back to reality. The melody of eating resumed.
How does he do anything? I wondered to myself. What happens when he’s dressing, goes to the lavatory, has a bath? I followed his wife into the kitchen and asked her how, for instance, he managed to dress himself. ‘It’s just like the eating,’ she explained. ‘I put his usual clothes out, in all the usual places, and he dresses without difficulty, singing to himself. He does everything singing to himself. But if he is interrupted and loses the thread, he comes to a complete stop, doesn’t know his clothes—or his own body. He sings all the time—eating songs, dressing songs, bathing songs, everything. He can’t do anything unless he makes it a song.’
While we were talking my attention was caught by the pictures on the walls.
‘Yes,’ Mrs P. said, ‘he was a gifted painter as well as a singer. The School exhibited his pictures every year.’
I strolled past them curiously—they were in chronological order. All his earlier work was naturalistic and realistic, with vivid mood and atmosphere, but finely detailed and concrete. Then, years later, they became less vivid, less concrete, less realistic and naturalistic, but far more abstract, even geometrical and cubist. Finally, in the last paintings, the canvasses became nonsense, or nonsense to me—mere chaotic lines and blotches of paint. I commented on this to Mrs P.
‘Ach, you doctors, you’re such Philistines!’ she exclaimed. ‘Can you not see artistic development—how he renounced the realism of his earlier years, and advanced into abstract, nonrepresentational art?’
‘No, that’s not it,’ I said to myself (but forbore to say it to poor Mrs P.). He had indeed moved from realism to nonrepresentation to the abstract, yet this was not the artist, but the pathology, advancing—advancing towards a profound visual agnosia, in which all powers of representation and imagery, all sense of the concrete, all sense of reality, were being destroyed. This wall of paintings was a tragic pathological exhibit, which belonged to neurology, not art.
And yet, I wondered, was she not partly right? For there is often a struggle, and sometimes, even more interestingly, a collusion between the powers of pathology and creation. Perhaps, in his cubist period, there might have been both artistic and pathological development, colluding to engender an original form; for as he lost the concrete, so he might have gained in the abstract, developing a greater sensitivity to all the structural elements of line, boundary, contour—an almost Picasso-like power to see, and equally depict, those abstract organisations embedded in, and normally lost in, the concrete. . . . Though in the final pictures, I feared, there was only chaos and agnosia.
We returned to the great music room, with the Bösendorfer in the centre, and Dr P. humming the last torte.
‘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?’
‘I 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 centre, now make it the whole, of your life.’
This was four years ago—I never saw him again, but I often wondered about how he apprehended the world, given his strange loss of image, visuality, and the perfect preservation of a great musicality. I think that music, for him, had taken the place of image. He had no body-image, he had body-music: this is why he could move and act as fluently as he did, but came to a total confused stop if the ‘inner music’ stopped. And equally with the outside, the world . . . (Thus, as I learned later from his wife, though he could not recognise his students if they sat still, if they were merely ‘images’, he might suddenly recognise them if they moved. ‘That’s Karl,’ he would cry. ‘I know his movements, his body-music’)
In The World as Representation and Will, Schopenhauer speaks of music as ‘pure will’. How fascinated he would have been by Dr P., a man who had wholly lost the world as representation, but wholly preserved it as music or will.
And this, mercifully, held to the end—for despite the gradual advance of his disease (a massive tumour or degenerative process in the visual parts of his brain) Dr P. lived and taught music to the last days of his life.
Postscript
How should one interpret Dr P.’s peculiar inability to interpret, to judge, a glove as a glove? Manifestly, here, he could not make a cognitive judgment, though he was prolific in the production of cognitive hypotheses. A judgment is intuitive, personal, comprehensive, and concrete—we ‘see’ how things stand, in relation to one another and oneself. It was precisely this setting, this relating, that Dr P. lacked (though his judging, in all other spheres, was prompt and normal). Was this due to lack of visual information, or faulty processing of visual information? (This would be the explanation given by a classical, schematic neurology.) Or was there something amiss in Dr P.’s attitude, so that he could not relate what he saw to himself?
Neurology and psychology, curiously, though they talk of everything else, almost never talk of ‘judgment’—and yet it is precisely the downfall of judgment (whether in specific realms, as with Dr P., or more generally, as in patients with Korsakov’s or frontal-lobe syndromes—see below, Chapters Twelve and Thirteen) which constitutes the essence of so many neuropsychological disorders. Judgment and identity may be casualties—but neuropsychology never speaks of them.
And yet, whether in a philosophic sense (Kant’s sense), or an empirical and evolutionary sense, judgment is the most important faculty we have. An animal, or a man, may get on very well without ‘abstract attitude’ but will speedily perish if deprived of judgment. Judgment must be the first faculty of higher life or mind—yet it is ignored, or misinterpreted, by classical (computational) neurology. And if we wonder how such an absurdity can arise, we find it in the assumptions, or the evolution, of neurology itself. For classical neurology (like classical physics) has always been mechanical—from Hughlings Jackson’s mechanical analogies to the computer analogies of today.
Of course, the brain is a machine and a computer—everything in classical neurology is correct. But our mental processes, which constitute our being and life, are not just abstract and mechanical, but personal, as well—and, as such, involve not just classifying and categorising, but continual judging and feeling also. If this is missing, we become computer-like, as Dr P. was. And, by the same token, if we delete feeling and judging, the personal, from the cognitive sciences, we reduce them to something as defective as Dr P.—and we reduce our apprehension of the concrete and real.
By a sort of comic and awful analogy, our current cognitive neurology and psychology resemble nothing so much as poor Dr P.! We need the concrete and real, as he did; and we fail to see this, as he failed to see it. Our cognitive sciences are themselves suffering from an agnosia essentially similar to Dr P.’s. Dr P. may therefore serve as a warning and parable—of what happens to a science which eschews the judgmental, the particular, the personal, and becomes entirely abstract and computational.
It was always a matter of great regret to me that, owing to circumstances beyond my control, I was not able to follow his case further, either in the sort of observations and investigations described, or in ascertaining the actual disease pathology.
One always fears that a case is ‘unique’, especially if it has such extraordinary features as those of Dr P. It was, therefore, with a sense of great interest and delight, not unmixed with relief, that I found, quite by chance—looking through the periodical Brain for 1956—a detailed description of an almost comically similar case, similar (indeed identical) neuropsychologically and phenomenologically, though the underlying pathology (an acute head injury) and all personal circumstances were wholly different. The authors speak of their case as ‘unique in the documented history of this disorder’—and evidently experienced, as I did, amazement at their own findings. (Only since the completion of this book have I found that there is, in fact, a rather extensive literature on visual agnosia in general, and prosopagnosia in particular. In particular I had the great pleasure recently of meeting Dr Andrew Kertesz, who has himself published some extremely detailed studies of patients with such agnosias (see, for example, his paper on visual agnosia, Kertesz 1979). Dr Kertesz mentioned to me a case known to him of a farmer who had developed prosopagnosia and in consequence could no longer distinguish (the faces of) his cows, and of another such patient, an attendant in a Natural History Museum, who mistook his own reflection for the diorama of an ape. As with Dr P., and as with Macrae and Trolle’s patient, it is especially the animate which is so absurdly misperceived. The most important studies of such agnosias, and of visual processing in general, are now being undertaken by A. R. and H. Damasio (see article in Mesulam [1985], pp. 259-288; or see p. 79 below).) The interested reader is referred to the original paper, Macrae and Trolle (1956), of which I here subjoin a brief paraphrase, with quotations from the original.
He had difficulty even recognising himself in a mirror, as Macrae and Trolle describe in detail: ‘In the early convalescent phase he frequently, especially when shaving, questioned whether the face gazing at him was really his own, and even though he knew it could physically be none other, on several occasions grimaced or stuck out his tongue “just to make sure.” By carefully studying his face in the mirror he slowly began to recognise it, but “not in a flash” as in the past—he relied on the hair and facial outline, and on two small moles on his left cheek.’
In general he could not recognise objects ‘at a glance’, but would have to seek out, and guess from, one or two features—occasionally his guesses were absurdly wrong. In particular, the authors note, there was difficulty with the animate.
On the other hand, simple schematic objects—scissors, watch, key, etc.—presented no difficulties. Macrae and Trolle also note that: ‘His topographical memory was strange: the seeming paradox existed that he could find his way from home to hospital and around the hospital, but yet could not name streets en route [unlike Dr P., he also had some aphasia] or appear to visualize the topography.’
It was also evident that visual memories of people, even from long before the accident, were severely impaired—there was memory of conduct, or perhaps a mannerism, but not of visual appearance or face. Similarly, it appeared, when he was questioned closely, that he no longer had visual images in his dreams. Thus, as with Dr P., it was not just visual perception, but visual imagination and memory, the fundamental powers of visual representation, which were essentially damaged in this patient—at least those powers insofar as they pertained to the personal, the familiar, the concrete.
A final, humorous point. Where Dr P. might mistake his wife for a hat, Macrae’s patient, also unable to recognise his wife, needed her to identify herself by a visual marker, by ‘. . . a conspicuous article of clothing, such as a large hat’.
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