The man who mistook his wife for a hat (21 page)

   It may be that such seizures have both a physiological and a personal origin, coming from particular charged parts of the brain but, equally, meeting particular psychic circumstances and needs: as in a case reported by Dennis Williams (1956):

   A representative, 31 (Case 2770), had major epilepsy induced by finding himself alone among strangers. Onset: a visual memory of his parents at home, the feeling 'How marvellous to be back'. It is described as a very pleasant memory. He gets gooseskin, goes hot and cold, and either the attack subsides or proceeds to a convulsion.

   Williams relates this astounding story baldly, and makes no connection between any of its parts. The emotion is dismissed as purely physiological-inappropriate 'ictal pleasure'-and the possible relation of 'being-back-home' to being lonely is equally ignored. He may, of course, be right; perhaps it all is entirely physiological; but I cannot help thinking that if one has to have seizures, this man, Case 2770, managed to have the right seizures at the right time.

   In Mrs O'C.'s case the nostalgic need was more chronic and profound, for her father died before she was born, and her mother before she was five. Orphaned, alone, she was sent to America, to live with a rather forbidding maiden aunt. Mrs O'C. had no conscious memory of the first five years of her life-no memory of her mother, of Ireland, of 'home'. She had always felt this as a keen and painful sadness-this lack, or forgetting, of the earliest, most precious years of her life. She had often tried, but never succeeded, to recapture her lost and forgotten childhood memories. Now, with her dream, and the long 'dreamy state' which succeeded it, she recaptured a crucial sense of her forgotten, lost childhood. The feeling she had was not just 'ictal pleasure', but a trembling, profound and poignant joy. It was, as she said, like the opening of a door-a door which had been stubbornly closed all her life.

   In her beautiful book on 'involuntary memories' (A
Collection of Moments,
1970), Esther Salaman speaks of the necessity to preserve, or recapture, 'the sacred and precious memories of childhood', and how impoverished,
ungrounded,
life is without these. She speaks of the deep joy, the sense of reality, which recapturing such memories may give, and she provides an abundance of marvellous autobiographical quotations, especially from Dostoievski and Proust. We are all 'exiles from our past', she writes, and, as such, we
need
to recapture it. For Mrs O'C, nearly ninety, approaching the end of a long lonely life, this recapturing of 'sacred and precious' childhood memories, this strange and almost miraculous anamnesis, breaking open the closed door, the amnesia of childhood, was provided, paradoxically, by a cerebral mishap.

   Unlike Mrs O'M. who found her seizures exhausting and tiresome, Mrs O'C. found hers a refreshment to the spirit. They gave her a sense of psychological grounding and reality, the elemental sense which she had lost, in her long decades of cut-offness and 'exile', that she
had
had a real childhood and home, that she
had
been mothered and loved and cared-for. Unlike Mrs O'M., who
wanted
treatment, Mrs O'C. declined anticonvulsants: 'I
need
these memories,' she would say. 'I need what's going on . . . And it'll end by itself soon enough.'

   Dostoievski had 'psychical seizures', or 'elaborate mental states' at the onset of seizures, and once said of these:

   You all, healthy people, can't imagine the happiness which we epileptics feel during the second before our fit… I don't know if this felicity lasts for seconds, hours or months, but believe me, I
would not exchange it for all the joys that life may bring.
(T. Alajouanine, 1963)

   Mrs O'C. would have understood this. She too knew, in her seizures, an extraordinary felicity. But it seemed to her the acme of sanity and health-the very key, indeed the door, to sanity and health. Thus she felt her illness as health, as
healing.

   As she got better, and recovered from her stroke, Mrs O'C. had a period of wistfulness and fear. 'The door is closing,' she said. 'I'm losing it all again.' And indeed she did lose, by the middle

   of April, the sudden irruptions of childhood scenes and music and feeling, her sudden epileptic 'transports' back to the world of early childhood-which were undoubtedly 'reminiscences', and authentic, for, as Penfield has shown beyond doubt, such seizures grasp and reproduce a reality-an experiential reality, and not a phantasy: actual segments of an individual's lifetime and past experience.

   But Penfield always speaks of 'consciousness' in this regard-of physical seizures as seizing, and convulsively replaying, part of the stream of consciousness, of conscious reality. What is peculiarly important, and moving, in the case of Mrs O'C., is that epileptic 'reminiscence' here seized on something unconscious-very early, childhood experiences, either faded, or repressed from consciousness-and restored them, convulsively, to full memory and consciousness. And it is for this reason, one must suppose, that though, physiologically, the 'door' did close, the experience itself was not forgotten, but left a profound and enduring impression, and was felt as a significant and healing experience. 'I'm glad it happened,' she said when it was over. 'It was the healthiest, happiest experience of my life. There's no longer a great chunk of childhood missing. I can't remember the details now, but I know it's all there. There's a sort of completeness I never had before.'

   These were not idle words, but brave and true. Mrs O'C.'s seizures did effect a kind of 'conversion', did give a centre to a centreless life, did give her back the childhood she had lost-and with this a serenity which she had never had before and which remained for the rest of her life: an ultimate serenity and security of spirit as is only given to those who possess, or recall, the true past.

   
Postscript

   'I have never been consulted for "reminiscence" only . . . ' said Hughlings Jackson; in contrast, Freud said, 'Neurosis is reminiscence.' But clearly the word is being used in quite opposite senses- for the aim of psychoanalysis, one might say, is to replace false or fantastic 'reminiscences' by a true memory, or anamnesis, of the past (and it is precisely such true memory, trivial or profound, that

   is evoked in the course of psychical seizures). Freud, we know, greatly admired Hughlings Jackson-but we do not know if Jackson, who lived to 1911, had ever heard of Freud.

   The beauty of a case like Mrs O'C.'s is that it is at once 'Jack-sonian' and 'Freudian'. She suffered from a Jacksonian 'reminiscence', but this served to moor and heal her, as a Freudian 'anamnesis'. Such cases are exciting and precious, for they serve as a bridge between the physical and personal, and they will point, if we let them, to the neurology of the future, a neurology of living experience. This would not, I think, have surprised or outraged Hughlings Jackson. Indeed it is surely what he himself dreamed of-when he wrote of 'dreamy states' and 'reminiscence' back in 1880.

   Penfield and Perot entitle their paper 'The Brain's Record of Visual and Auditory Experience', and we may now meditate on the form, or forms, such inner 'records' may have. What occurs, in these wholly personal 'experiential' seizures, is an entire replay of (a segment of) experience. What, we may ask,
could
be played in such a way as to reconstitute an experience? Is it something akin to a film or record, played on the brain's film projector or phonograph? Or something analogous, but logically anterior- such as a script or score? What is the final form, the natural form, of our life's repertoire? That repertoire which provides not only memory and 'reminiscence', but our imagination at every level, from the simplest sensory and motor images, to the most complex imaginative worlds, landscapes, scenes? A repertoire, a memory, an imagination, of a life which is essentially personal, dramatic and 'iconic'.

   The experiences of reminiscence our patients have raise fundamental questions about the nature of memory (or
mnesis)
-these are also raised, in reverse, in our tales of amnesia or amnesis ('The Lost Mariner' and 'A Matter of Identity', Chapters Two and Twelve). Analogous questions about the nature of knowing (or
gnosis) are
raised by our patients with agnosias-the dramatic visual agnosia of Dr P. (The Man Who Mistook His Wife for a Hat'), and the auditory and musical agnosias of Mrs O'M. and Emily D. (Chapter Nine, The President's Speech'). And similar questions about the nature of action (or
praxis)
are raised by the motor bewilder-

   ment, or apraxia, of certain retardates, and by patients with frontal-lobe apraxias-apraxias which may be so severe that such patients may be unable to walk, may lose their 'kinetic melodies', their melodies of walking (this also happens in Parkinsonian patients, as was seen in
Awakenings).

   As Mrs O'C. and Mrs O'M. suffered from 'reminiscence', a convulsive upsurge of melodies and scenes-a sort of
hyper-mnesis
and
hyper
-gnosis-our amnesic-agnosic patients have lost (or are losing) their inner melodies and scenes. Both alike testify to the essentially 'melodic' and 'scenic' nature of inner life, the 'Prous-tian' nature of memory and mind.

   Stimulate a point in the cortex of such a patient, and there convulsively unrolls a Proustian evocation or reminiscence. What mediates this, we wonder? What sort of cerebral organisation could allow this to happen? Our current concepts of cerebral processing and representation are all essentially computational (see, for example, David Marr's brilliant book,
Vision: A Computational Investigation of Visual Representation in Man,
1982). And, as such, they are couched in terms of 'schemata', 'programmes', 'algorithms', etc.

   But could schemata, programmes, algorithms alone provide for us the richly visionary, dramatic and musical quality of experience-that vivid personal quality which
makes
it 'experience'?

   The answer is clearly, even passionately, 'No!' Computational representations-even of the exquisite sophistication envisaged by Marr and Bernstein (the two greatest pioneers and thinkers in this realm)-could never, of themselves, constitute 'iconic' representations, those representations which are the very thread and stuff of life.

   Thus a gulf appears, indeed a chasm, between what we learn from our patients and what physiologists tell us. Is there any way of bridging this chasm? Or, if that is (as it may be) categorically impossible, are there any concepts beyond those of cybernetics by which we may better understand the essentially personal, Proustian nature of reminiscence of the mind, of life? Can we, in short, have a personal or Proustian physiology, over and above the mechanical, Sherringtonian one? (Sherrington himself hints at this

   in
Man on His Nature
(1940), when he imagines the mind as 'an enchanted loom', weaving ever-changing yet always meaningful patterns-weaving, in effect, patterns of meaning . . . )

   Such patterns of meaning would indeed transcend purely formal or computational programmes or patterns, and allow the essentially
personal
quality which is inherent in reminiscence, inherent in
all
mnesis, gnosis, and praxis. And if we ask what form, what organisation, such patterns could have, the answer springs immediately (and, as it were, inevitably) to mind. Personal patterns, patterns for the individual, would have to take the form of scripts or scores-as abstract patterns, patterns for a computer, must take the form of schemata or programmes. Thus, above the level of cerebral programmes, we must conceive a level of cerebral scripts and scores.

   The score of 'Easter Parade', I conjecture, is indelibly inscribed in Mrs O'M.'s brain-the score,
her
score, of all she heard and felt at the original moment and imprinting of the experience. Similarly, in the 'dramaturgic' portions of Mrs O'C.'s brain, apparently forgotten, but none the less totally recoverable, must have lain, indelibly inscribed, the script of
her
dramatic, childhood scene.

   And let us note, from Penfield's cases, that the removal of the minute, convulsing point of cortex, the irritant focus causing reminiscence, can remove
in toto
the iterating scene, and replace an absolutely specific reminiscence or 'hyper-mnesia' by an equally specific oblivion or amnesia. There is something extremely important, and frightening here: the possibility of a
real
psycho-surgery, a neurosurgery of identity (infinitely finer and more specific than our gross amputations and lobotomies, which may damp or deform the whole character, but cannot touch individual experiences).

   Experience is not
possible
until it is organised iconically; action is not
possible
unless it is organised iconically. 'The brain's record' of everything-everything alive-must be iconic. This is the
final
form of the brain's record, even though the preliminary form may be computational or programmatic. The final form of cerebral representation must be, or allow, 'art'-the artful scenery and melody of experience and action.

   By the same token, if the brain's representations are damaged or destroyed, as in the amnesias, agnosias, apraxias, their recon-stitution (if possible) demands a double approach-an attempt to reconstruct damaged programs and systems-as is being developed, extraordinarily, by Soviet neuropsychology; or a direct approach at the level of inner melodies and scenes (as described in
Awakenings, A Leg to Stand On
and several cases in this book, especially 'Rebecca' (Chapter Twenty-one) and the introduction to Part Four). Either approach may be used-or both may be used in conjunction-if we are to understand, or assist, brain-damaged patients: a 'systematic' therapy, and an 'art' therapy, preferably both.

   All of this was hinted at a hundred years ago-in Hughlings Jackson's original account of'reminiscence' (1880); by Korsakoff, on amnesia (1887); and by Freud and Anton in the 1890s, on agnosias. Their remarkable insights have been half-forgotten, eclipsed by the rise of a systematic physiology. Now is the time to recall them, re-use them, so that there may arise, in our own time, a new and beautiful 'existential' science and therapy, which can join with the systematic, to give us a comprehensive understanding and power.