The man who mistook his wife for a hat (31 page)

   'I have been thinking about you, Jose,' I said. He might not understand my words, but he understood my tone. 'I want to see more drawing'-and I gave him my pen.

   What should I ask him to draw this time? I had, as always, a copy of
Arizona Highways
with me, a richly illustrated magazine which I especially delight in, and which I carry around for neurological purposes, for testing my patients. The cover depicted an idyllic scene of people canoeing on a lake, against a backdrop of

   mountains and sunset. Jose started with the foreground, a mass of near-black silhouetted against the water, outlined this with extreme accuracy, and started to block it in. But this was clearly a job for a paintbrush, not a fine pen. 'Skip it,' I said, then pointing, 'Go on to the canoe.' Rapidly, unhesitatingly, Jose outlined the silhouetted figures and the canoe. He looked at them, then looked away, their forms fixed in his mind-then swiftly blocked them in with the side of the pen.

   Here again, and more impressively, because an entire scene was involved, I was amazed at the swiftness and the minute accuracy of reproduction, the more so since Jose had gazed at the canoe and then away, having taken it in. This argued strongly against any mere copying-the attendant had said earlier, 'He's just a Xerox'-and suggested that he had apprehended it as an image, exhibiting a striking power not just of copying but of perception. For the image had a dramatic quality not present in the original. The tiny figures, enlarged, were more intense, more alive, had a feeling of involvement and purpose not at all clear in the original. All the hallmarks of what Richard Wollheim calls 'icon-icity'-subjectivity, intentionality, dramatisation-were present. Thus, over and above the powers of mere facsimile, striking as

   these were, he seemed to have clear powers of imagination and creativity. It was not
a
canoe but
his
canoe that emerged in the drawing.

   I turned to another page in the magazine, to an article on trout fishing, with a pastel watercolour of a trout stream, a background of rocks and trees, and in the foreground a rainbow trout about to take a fly. 'Draw this,' I said, pointing to the fish. He gazed at it intently, seemed to smile to himself, and then turned away-and now, with obvious enjoyment, his smile growing broader and broader, he drew a fish of his own.

   I smiled myself, involuntarily, as he drew it, because now, feeling comfortable with me, he was letting himself go, and what was emerging, slyly, was not just a fish, but a fish with a 'character' of sorts.

   The original had lacked character, had looked lifeless, two-dimensional, even stuffed. Jose's fish, by contrast, tilted and poised, was richly three-dimensional, far more like a real fish than the original. It was not only verisimilitude and animation that had been added but something else, something richly expressive, though not wholly fishlike: a great, cavernous, whalelike mouth; a slightly crocodilian snout; an eye, one had to say, which was distinctly human, and with altogether a positively roguish look. It was a very

   funny fish-no wonder he had smiled-a sort of fish-person, a nursery character, like the frog-footman in
Alice.

   Now I had something to go on. The picture of the clock had startled me, stimulated my interest, but did not, in itself, allow any thoughts or conclusions. The canoe had shown that Jose had an impressive visual memory, and more. The fish showed a lively and distinctive imagination, a sense of humour, and something akin to fairy-tale art. Certainly not great art, it was 'primitive', perhaps it was child-art; but, without doubt, it was art of a sort. And imagination, playfulness, art are precisely what one does not expect in idiots, or
idiots savants,
or in the autistic either. Such at least is the prevailing opinion.

   My friend and colleague Isabelle Rapin had actually seen Jose years before, when he was presented with 'intractable seizures' in the child neurology clinic-and she, with her great experience, did not doubt that he was 'autistic'. Of autism in general she had written:

   A small number of autistic children are exceedingly proficient at decoding written language and become hyperlexic or preoccupied with numbers . . . Extraordinary proficiencies of some autistic children for putting together puzzles, taking apart mechanical toys, or decoding written texts may reflect the consequences of attention and learning being inordinately focused on non-verbal visual-spatial tasks to the exclusion of, or perhaps because of, the lack of demand for learning verbal skills. (1982, pp. 146-50)

   Somewhat similar observations, specifically about drawing, are made by Lorna Selfe in her astonishing book
Nadia
(1978). All
idiot savant
or autistic proficiencies and performances, Dr Selfe gathered from the literature, were apparently based on calculation and memory alone, never on anything imaginative or personal. And if these children could draw-supposedly a very rare occurrence-their drawings too were merely mechanical. 'Isolated islands of proficiency' and 'splinter skills' are spoken of in the literature. No allowance is made for an individual, let alone a creative, personality.

   What then was Jose, I had to ask myself. What sort of being? What went on inside him? How had he arrived at the state he was in? And what state was it-and might anything be done?

   I was both assisted and bewildered by the available information-the mass of 'data' that had been gathered since the first onset of his strange illness, his 'state'. I had a lengthy chart available to me, containing early descriptions of his original illness: a very high fever at the age of eight, associated with the onset of incessant, and subsequently continuing, seizures, and the rapid appearance of a brain-damaged or autistic condition. (There had been doubt from the start about what, exactly, was going on.)

   His spinal fluid had been abnormal during the acute stage of the illness. The consensus was that he had probably suffered an encephalitis of sorts. His seizures were of many different types-
petit mal, grand mal,
'akinetic', and 'psychomotor', these last being seizures of an exceptionally complex type.

   Psychomotor seizures can also be associated with sudden passion and violence, and the occurrence of peculiar behaviour-states even between seizures (the so-called psychomotor personality). They are invariably associated with disorder in, or damage to, the temporal lobes, and severe temporal-lobe disorder, both left-sided and right-sided, had been demonstrated in Jose by innumerable EEGs.

   The temporal lobes are also associated with the auditory capacities, and, in particular, the perception and production of speech. Dr Rapin had not only considered Jose 'autistic', but had wondered whether a temporal-lobe disorder had caused a 'verbal auditory agnosia'-an inability to recognise speech sounds that interfered with his capacity to use or understand the spoken word. For what was striking, however it was to be interpreted (and both psychiatric and neurological interpretations were offered), was the loss or regression of speech, so that Jose, previously 'normal' (or so his parents avowed), became 'mute', and ceased talking to others when he became ill.

   One capacity was apparently 'spared'-perhaps in a compensatory way enhanced: an unusual passion and power to draw, which had been evident since early childhood, and seemed to some extent hereditary or familial, for his father had always been fond of

   sketching, and his (much) older brother was a successful artist. With the onset of his illness; with his seemingly intractable seizures (he might have twenty or thirty major convulsions a day, and uncounted 'little seizures', falls, 'blanks', or 'dreamy states'); with the loss of speech and his general intellectual and emotional 'regression', Jose found himself in a strange and tragic state. His schooling was discontinued, though a private tutor was provided for a while, and he was returned permanently to his family, as a 'fulltime' epileptic, autistic, perhaps aphasic, retarded child. He was considered ineducable, untreatable and generally hopeless. At the age of nine, he 'dropped out'-out of school, out of society, out of almost all of what for a normal child would be 'reality'.

   For fifteen years he scarcely emerged from the house, ostensibly because of'intractable seizures', his mother maintaining she dared not take him out, otherwise he would have twenty or thirty seizures in the street every day. All sorts of anticonvulsants were tried, but his epilepsy seemed 'untreatable': this, at least, was the stated opinion in his chart. There were older brothers and sisters, but Jose was much the youngest-the 'big baby' of a woman approaching fifty.

   We have far too little information about these intervening years. Jose, in effect, disappeared from the world, was 'lost to follow-up', not only medically but generally, and might have been lost forever, confined and convulsing in his cellar room, had he not 'blown up' violently very recently and been taken to the hospital for the first time. He was not entirely without inner life, in the cellar. He showed a passion for pictorial magazines, especially of natural history, of the
National Geographic
type, and when he was able, between seizures and scoldings, would find stumps of pencil and draw what he saw.

   These drawings were perhaps his only link with the outside world, and especially the world of animals and plants, of nature, which he had so loved as a child, especially when he went out sketching with his father. This, and this only, he was permitted to retain, his one remaining link with reality.

   This, then, was the tale I received, or, rather, put together from his chart or charts, documents as remarkable for what they lacked

   as for what they contained-the documentation, through default, of a fifteen-year 'gap': from a social worker who had visited the house, taken an interest in him, but could do nothing; and from his now aged and ailing parents as well. But none of this would have come to light had there not been a rage of sudden, unprecedented, and frightening violence-a fit in which objects were smashed-which brought Jose to a state hospital for the first time.

   It was far from clear what had caused this rage, whether it was an eruption of epileptic violence (such as one may see, on rare occasions, with very severe temporal-lobe seizures), or whether it was, in the simplistic terms of his admission note, simply 'a psychosis', or whether it represented some final, desperate call for help, from a tortured soul who was mute and had no direct way of expressing his predicament, his needs.

   What was clear was that coming to the hospital and having his seizures 'controlled' by powerful new drugs, for the first time, gave him some space and freedom, a 'release', both physiological and psychological, of a sort he had not known since the age of eight.

   Hospitals, state hospitals, are often seen as 'total institutions' in Erving Goffman's sense, geared mainly to the degradation of patients. Doubtless this happens, and on a vast scale. But they may also be 'asylums' in the best sense of the word, a sense perhaps scarcely allowed by Goffman: places that provide a refuge for the tormented, storm-tossed soul, provide it with just that mixture of order and freedom of which it stands in such need. Jose had suffered from confusion and chaos-partly organic epilepsy, partly the disorder of his life-and from confinement and bondage, also both epileptic and existential. Hospital was good for Jose, perhaps lifesaving, at this point in his life, and there is no doubt that he himself felt this fully.