The man who mistook his wife for a hat (25 page)

   I call this an inversion because the concrete is elemental-it is what makes reality 'real', alive, personal and meaningful. All of this is lost if the concrete is lost-as we saw in the case of the

   *All of Luria's early work was done in these three allied domains, his field-work with children in primitive communities in Central Asia, and his studies in the Institute of Defectology. Together these launched his lifelong exploration of human imagination.

   almost-Martian Dr P., 'the man who mistook his wife for a hat', who fell (in an un-Goldsteinian way) from the concrete
to
the abstract.

   Much easier to comprehend, and altogether more natural, is the idea of the preservation of the concrete in brain damage-not regression
to
it, but preservation of it, so that the essential personality and identity and humanity, the
being
of the hurt creature, is preserved.

   This is what we see in Zazetsky-'the man with a shattered world'-he remains a man, quintessentially a man, with all the moral weight and rich imagination of a man, despite the devastation of his abstract and propositional powers. Here Luria, while seeming to be supporting the formulations of Hughlings Jackson and Goldstein, is, at the same time, turning their significance upside down. Zazetsky is no feeble Jacksonian or Goldsteinian relic, but a man in his full manhood, a man with his emotions and imagination wholly preserved, perhaps enhanced. His world is not 'shattered', despite the book's title-it lacks unifying abstractions, but is experienced as an extraordinarily rich, deep and concrete reality.

   I believe all this to be true of the simple also-the more so as, having been simple from the start, they have never known, been seduced by, the abstract, but have always experienced reality direct and unmediated, with an elemental and, at times, overwhelming intensity.

   We find ourselves entering a realm of fascination and paradox, all of which centres on the ambiguity of the 'concrete'. In particular, as physicians, as therapists, as teachers, as scientists, we are invited, indeed compelled, towards
an exploration of the concrete.
This
is
Luria's 'romantic science'. Both of Luria's great clinical biographies, or 'novels', may indeed be seen as explorations of the concrete: its preservation, in the service of reality, in the braindamaged Zazetsky; its exaggeration, at the expense of reality, in the 'supermind' of the Mnemonist.

   Classical science has no use for the concrete-it is equated with the trivial in neurology and psychiatry. It needs a 'romantic' science to pay it its full due-to appreciate its extraordinary powers . . . and dangers: and in the simple we are confronted with the

   concrete head-on, the concrete pure and simple, in unreserved intensity.

   The concrete can open doors, and it can close them too. It can constitute the portal to sensibility, imagination, depth. Or it can confine the possessor (or the possessed) to meaningless particulars. We see both of these potentials, as it were amplified, in the simple.

   Enhanced powers of concrete imagery and memory, Nature's compensation for defectiveness in the conceptual and abstract, can tend in quite opposite directions: towards an obsessive preoccupation with particulars, the development of an eidetic imagery and memory, and the mentality of the Performer or 'whiz kid' (as occurred with the Mnemonist, and in ancient times, with over-cultivation of the concrete 'art of memory'*: we see tendencies to this in Martin A. (Chapter Twenty-two), in Jose (Chapter Twenty-four), and especially the Twins (Chapter Twenty-three), exaggerated, especially in the Twins, by the demands of public performance, coupled with their own obsessionalism and exhibitionism.

   But of much greater interest, much more human, much more moving, much more 'real'-yet scarcely even recognised in scientific studies of the simple (though immediately seen by sympathetic parents and teachers)-is the
proper
use and development of the concrete.

   The concrete, equally, may become a vehicle of mystery, beauty and depth, a path into the emotions, the imagination, the spirit- fully as much as any abstract conception (perhaps indeed more, as Gershom Scholem (1965) has argued in his contrasts of the conceptual and the symbolic, or Jerome Bruner (1984) in his contrast of the 'paradigmatic' and the 'narrative'). The concrete is readily imbued with feeling and meaning-more readily, perhaps, than any abstract conception. It readily moves into the aesthetic, the dramatic, the comic, the symbolic, the whole wide deep world of art and spirit.
Conceptually,
then, mental defectives may be cripples-but in their powers of concrete and symbolic apprehen-

   *See Francis Yates' extraordinary book so titled (1966).

   sion they may be fully the equal of any 'normal' individual. (This is science, this is romance too . . . ) No one has expressed this more beautifully than Kierkegaard, in the words he wrote on his deathbed.
'Thou plain man!'
(he writes, and I paraphrase slightly). 'The symbolism of the Scriptures is something infinitely high . . . but it is not "high" in a sense that has anything to do with
intellectual
elevation, or with the
intellectual
differences between man and man . . . No, it is for all . . . for all is this infinite height attainable.'

   A man may be very 'low' intellectually-unable to put a key to a door, much less understand the Newtonian laws of motion, wholly unable to comprehend the world
as concepts,
and yet fully able, and indeed gifted, in understanding the world as concrete-ness,
as symbols.
This is the other side, the almost sublime other side, of the singular creatures, the gifted simpletons, Martin, Jose, and the Twins.

   Yet, it may be said, they are extraordinary and atypical. I therefore start this final section with Rebecca, a wholly 'unremarkable' young woman, a simpleton, with whom I worked twelve years ago. I remember her warmly.

   
21

   
Rebecca

   Rebecca was no child when she was referred to our clinic. She was nineteen, but, as her grandmother said, 'just like a child in some ways'. She could not find her way around the block, she could not confidently open a door with a key (she could never 'see' how the key went, and never seemed to learn). She had left/ right confusion, she sometimes put on her clothes the wrong way- inside out, back-to-front, without appearing to notice, or, if she noticed, without being able to get them right. She might spend hours jamming a hand or foot into the wrong glove or shoe-she seemed, as her grandmother said, to have 'no sense of space'. She was clumsy and ill-coordinated in all her movements-a 'klutz', one report said, a 'motor moron' another (although when she danced, all her clumsiness disappeared).

   Rebecca had a partial cleft palate, which caused a whistling in her speech; short, stumpy fingers, with blunt, deformed nails; and a high, degenerative myopia requiring very thick spectacles-all stigmata of the same congenital condition which had caused her cerebral and mental defects. She was painfully shy and withdrawn, feeling that she was, and had always been, a 'figure of fun'.

   But she was capable of warm, deep, even passionate attachments. She had a deep love for her grandmother, who had brought her up since she was three (when she was orphaned by the death of both parents). She was very fond of nature, and, if she was taken to the city parks and botanic gardens, spent many happy hours there. She was very fond too of stories, though she never learned to read (despite assiduous, and even frantic, attempts), and would implore her grandmother or others to read to her. 'She has a

   hunger for stories,' her grandmother said; and fortunately her grandmother loved reading stories and had a fine reading voice which kept Rebecca entranced. And not just stories-poetry too. This seemed a deep need or hunger in Rebecca-a necessary form of nourishment, of reality, for her mind. Nature was beautiful, but mute. It was not enough. She needed the world re-presented to her in verbal images, in language, and seemed to have little difficulty following the metaphors and symbols of even quite deep poems, in striking contrast to her incapacity with simple propositions and instructions. The language of feeling, of the concrete, of image and symbol, formed a world she loved and, to a remarkable extent, could enter. Though conceptually (and 'proposition-ally') inept, she was at home with poetic language, and was herself, in a stumbling, touching way, a sort of 'primitive', natural poet. Metaphors, figures of speech, rather striking similitudes, would come naturally to her, though unpredictably, as sudden poetic ejaculations or allusions. Her grandmother was devout, in a quiet way, and this also was true of Rebecca: she loved the lighting of the Sabbath candles, the benisons and orisons which thread the Jewish day; she loved going to the synagogue, where she too was loved (and seen as a child of God, a sort of innocent, a holy fool); and she fully understood the liturgy, the chants, the prayers, rites and symbols of which the Orthodox service consists. All this was possible for her, accessible to her, loved by her, despite gross perceptual and spatio-temporal problems, and gross impairments in every schematic capacity-she could not count change, the simplest calculations defeated her, she could never learn to read or write, and she would average 60 or less in
IQ
tests (though doing notably better on the verbal than the performance parts of the test). Thus she was a 'moron', a 'fool', a 'booby', or had so appeared, and so been called, throughout her whole life, but one with an unexpected, strangely moving, poetic power. Superficially she
was
a mass of handicaps and incapacities, with the intense frustrations and anxieties attendant on these; at this level she was, and felt herself to be, a mental cripple-beneath the effortless skills, the happy capacities, of others; but at some deeper level there was no sense of handicap or incapacity, but a feeling of calm and com-

   pleteness, of being fully alive, of being a soul, deep and high, and equal to all others. Intellectually, then, Rebecca felt a cripple; spiritually she felt herself a full and complete being.

   When I first saw her-clumsy, uncouth, all-of-a-fumble-I saw her merely, or wholly, as a casualty, a broken creature, whose neurological impairments I could pick out and dissect with precision: a multitude of apraxias and agnosias, a mass of sensorimotor impairments and breakdowns, limitations of intellectual schemata and concepts similar (by Piaget's criteria) to those of a child of eight. A poor thing, I said to myself, with perhaps a 'splinter skill', a freak gift, of speech; a mere mosaic of higher cortical functions, Piagetian schemata-most impaired.

   The next time I saw her, it was all very different. I didn't have her in a test situation, 'evaluating' her in a clinic. I wandered outside-it was a lovely spring day-with a few minutes in hand before the clinic started, and there I saw Rebecca sitting on a bench, gazing at the April foliage quietly, with obvious delight. Her posture had none of the clumsiness which had so impressed me before. Sitting there, in a light dress, her face calm and slightly smiling, she suddenly brought to mind one of Chekov's young women-Irene, Anya, Sonya, Nina-seen against the backdrop of a Chekovian cherry orchard. She could have been any young woman enjoying a beautiful spring day. This was my human, as opposed to my neurological, vision.

   As I approached, she heard my footsteps and turned, gave me a broad smile, and wordlessly gestured. 'Look at the world,' she seemed to say. 'How beautiful it is.' And then there came out, in Jacksonian spurts, odd, sudden, poetic ejaculations: 'spring', 'birth', 'growing', 'stirring', 'coming to life', 'seasons', 'everything in its time'. I found myself thinking of Ecclesiastes: 'To everything there is a season, and a time to every purpose under the heaven. A time to be born, and a time to die; a time to plant, and a time . . . ' This was what Rebecca, in her disjointed fashion, was ejaculating-a vision of seasons, of times, like that of the Preacher. 'She is an idiot Ecclesiastes,' I said to myself. And in this phrase, my two visions of her-as idiot and as symbolist-met, collided and fused. She had done appallingly in the testing-which, in a sense,

   was designed, like all neurological and psychological testing, not merely to uncover, to bring out deficits, but to decompose her into functions and deficits. She had come apart, horribly, in formal testing, but now she was mysteriously 'together' and composed.

   Why was she so decomposed before, how could she be so re-composed now? I had the strongest feeling of two wholly different modes of thought, or of organisation, or of being. The first schematic-pattern-seeing, problem-solving-this is what had been tested, and where she had been found so defective, so disastrously wanting. But the tests had given no inkling of anything
but
the deficits, of anything, so to speak,
beyond
her deficits.

   They had given me no hint of her positive powers, her ability to perceive the real world-the world of nature, and perhaps of the imagination-as a coherent, intelligible, poetic whole: her ability to see this, think this, and (when she could) live this; they had given me no intimation of her inner world, which clearly
was
composed and coherent, and approached as something other than a set of problems or tasks.

   But what was the composing principle which could allow her composure (clearly it was something other than schematic)? I found myself thinking of her fondness for tales, for narrative composition and coherence. Is it possible, I wondered, that this being before me-at once a charming girl, and a moron, a cognitive mishap- can
use
a narrative (or dramatic) mode to compose and integrate a coherent world, in place of the schematic mode, which, in her, is so defective that it simply doesn't work? And as I thought, I remembered her dancing, and how this could organise her otherwise ill-knit and clumsy movements.

   Our tests, our approaches, I thought, as I watched her on the bench-enjoying not just a simple but a sacred view of nature- our approach, our 'evaluations', are ridiculously inadequate. They only show us deficits, they do not show us powers; they only show us puzzles and schemata, when we need to see music, narrative, play, a being conducting itself spontaneously in its own natural way.