The man who mistook his wife for a hat (33 page)

   I think Jose, an autist, a simpleton too, has such a gift for the concrete, for
form,
that he is, in his way, a naturalist and natural artist. He grasps the world as forms-directly and intensely felt forms-and reproduces them. He has fine literal powers, but he has figurative powers too. He can draw a flower or fish with remarkable accuracy, but he can also make one which is a personification, an emblem, a dream, or a joke. And the autistic are supposed to lack imagination, playfulness, art!

   Creatures like Jose are not supposed to exist. Autistic child-artists like 'Nadia' were not supposed to exist. Are they indeed so rare, or are they overlooked? Nigel Dennis, in a brilliant essay on Nadia in the
New York Review of Books
(4 May 1978), wonders how many of the world's 'Nadias' may be dismissed or overlooked, their remarkable productions crumpled up and consigned to the trash can, or simply, like Jose, treated without thought, as an odd talent, isolated, irrelevant, of no interest. But the autistic artist or (to be less lofty) the autistic imagination is by no means rare. I have seen a dozen examples of it in as many years, and this without making any particular effort to find them.

   The autistic, by their nature, are seldom open to influence. It is their 'fate' to be isolated, and thus original. Their 'vision', if it can be glimpsed, comes from within and appears aboriginal. They seem to me, as I see more of them, to be a strange species in our midst, odd, original, wholly inwardly directed, unlike others.

   Autism was once seen as a childhood schizophrenia, but phe-nomenologically the reverse is the case. The schizophrenic's complaint is always of 'influence' from the outside: he is passive, he is played upon, he cannot be himself. The autistic would complain-if they complained-of absence of influence, of absolute isolation.

   'No man is an island, entire of itself,' wrote Donne. But this is precisely what autism is-an island, cut off from the main. In 'classical' autism, which is manifest, and often total, by the third year of life, the cutting off is so early there may be no memory of

   the main. In 'secondary' autism, like Jose's, caused by brain disease at a later stage in life, there is some memory, perhaps some nostalgia, for the main. This may explain why Jose was more accessible than most, and why, at least in drawing, he may show interplay taking place.

   Is being an island, being cut off, necessarily a death? It may be a death, but it is not necessarily so. For though 'horizontal' connections with others, with society and culture, are lost, yet there may be vital and intensified 'vertical' connections, direct connections with nature, with reality, uninfluenced, unmediated, untouchable, by any others. This 'vertical' contact is very striking with Jose, hence the piercing directness, the absolute clarity of his perceptions and drawings, without a hint or shade of ambiguity or indirection, a rocklike power uninfluenced by others.

   This brings us to our final question: is there any 'place' in the world for a man who is like an island, who cannot be acculturated, made part of the main? Can 'the main' accommodate, make room for, the singular? There are similarities here to the social and cultural reactions to genius. (Of course I do not suggest that all autists have genius, only that they share with genius the problem of singularity.) Specifically: what does the future hold for Jose? Is there some 'place' for him in the world which will
employ
his autonomy, but leave it intact?

   Could he, with his fine eye, and great love of plants, make illustrations for botanical works or herbals? Be an illustrator for zoology or anatomy texts? (See the drawing overleaf he made for me when I showed him a textbook illustration of the layered tissue called 'ciliated epithelium'.) Could he accompany scientific expeditions, and make drawings (he paints and makes models with equal facility) of rare species? His pure concentration on the thing before him would make him ideal in such situations.

   Or, to take a strange but not illogical leap, could he, with his peculiarities, his idiosyncrasy, do drawings for fairy tales, nursery tales, Bible tales, myths? Or (since he cannot read, and sees letters only as pure and beautiful forms) could he not illustrate, and elaborate, the gorgeous capitals of manuscript breviaries and missals? He has done beautiful altarpieces, in mosaic and stained

   wood, for churches. He has carved exquisite lettering on tombstones. His current 'job' is hand-printing sundry notices for the ward, which he does with the flourishes and elaborations of a latter-day Magna Carta. All this he could do, and do very well. And it would be of use and delight to others, and delight him too. He could do all of these-but, alas, he will do none, unless someone very understanding, and with opportunities and means, can guide and employ him. For, as the stars stand, he will probably do nothing, and spend a useless, fruitless life, as so many other autistic people do, overlooked, unconsidered, in the back ward of a state hospital.

   
Postscript

   After publication of this piece, I again received many offprints and letters, the most interesting being from Dr C.C. Park. It is indeed clear (as Nigel Dennis suspected) that even though 'Nadia' may

   Ciliated epithelium from the trachea of a kitten (magnified 255 times).

   have been unique-a sort of Picasso-artistic gifts of fairly high order are not uncommon among the autistic. Testing for artistic potential, as in the Goodenough 'Draw-a-Man' intelligence test, is almost useless: there must occur, as with 'Nadia', Jose and the Parks' 'Ella', a
spontaneous
production of striking drawings.

   In an important and richly illustrated review of'Nadia', Dr Park (1978) brings out, on the basis of experience with her own child, no less than from a perusal of the world literature, what seem to be the cardinal characteristics of such drawings. These include 'negative' characteristics, such as derivativeness and stereotypy, and 'positive' ones, such as an unusual capacity for delayed rendition, and for rendering the object as
perceived
(not as conceived): hence the sort of inspired naivete especially seen. She also notes a relative indifference to display of others' reactions, which might seem to render such children untrainable. And yet, manifestly, this need not be the case. Such children are not necessarily unresponsive to teaching or attention, though this may need to be of a very special type.

   In addition to experience with her own child, who is now an accomplished adult artist, Dr Park cites also the fascinating and insufficiently known experiences of the Japanese, especially Mor-ishima and Motzugi, who have had remarkable success in bringing autists from an untutored (and seemingly unteachable) childhood giftedness to professionally accomplished adult artistry. Morishima favours special instructional techniques ('highly structured skill training'), a sort of apprenticeship in the classical Japanese cultural tradition, and encouragement of drawing
as a means of communication.
But such formal training, though crucial, is not enough. A most intimate, empathic relationship is required. The words with which Dr Park concludes her review may properly conclude 'The World of the Simple':

   The secret may lie elsewhere, in the dedication that led Motzugi to live with another retarded artist in his home, and to write: 'The secret in developing Yanamura's talent was to share his spirit. The teacher should love the beautiful, honest retarded person, and live with a purified, retarded world.'

   
Bibliography

   
GENERAL REFERENCES

   Hughlings Jackson, Kurt Goldstein, Henry Head, A. R. Luria-these are the fathers of neurology who lived intensely, and thought intensely, about patients and problems not so dissimilar to our own. They are always present, in the neurologist's mind, and they haunt the pages of this book. There is a tendency to reduce complex figures to stereotypes, to disallow the fullness, and often the rich contradictoriness, of their thought. Thus 1 often talk about classical "Jacksonian" neurology, but the Hughlings Jackson who wrote of "dreamy states" and "reminiscence" was very different from the Jackson who saw all thought as propositional calculus. The former was a poet, the latter a logician, and yet they are one and the same man. Henry Head the diagram-maker, with his passion for schematics, was very different from the Head who wrote poignantly of "feeling-tone." Goldstein, who wrote so abstractly of "the Abstract," delighted in the rich concreteness of individual cases. In Luria, finally, the doubleness was conscious: he had, he felt, to write two sorts of books: formal, structural books (like
Higher Cortical Functions in Man)
and biographical "novels" (like
The Mind of a Mnemonist).
The first he called "Classical Science," the second, "Romantic Science."

   Jackson, Goldstein, Head, and Luria-they constitute the essential axis of neurology, and certainly they are the axis of my own thinking and of this book. My first references must therefore be to them-ideally to everything they wrote, for what is most characteristic is always suffused through a life's work, but for the sake of practicality to certain key-works which are the most accessible to English-speaking readers.

   
Hughlings Jackson

   There are wonderful descriptions of cases before Hughlings Jackson- such as Parkinson's "Essay on the Shaking Palsy," as early as 1817-but no general vision or systemization of nervous function. Jackson is the founder of neurology as a science. One can browse through the basic volumes of Jacksoniana: Taylor, J.,
Selected Writings of John Hughlings Jackson.
London: 1931; repr. New York: 1958. These writings are not easy reading, though often evocative and dazzlingly clear in parts. A further selection, with records of Jackson's conversations and a memoir, had been almost completed by Purdon Martin at the time of his recent death, and will, it is Jioped, be published in this sesquicentennial year of Jackson's birth.

   
Henry Head

   Head, like Weir Mitchell (see below under Chapter 6), is a marvellous writer, and
his
heavy volumes, unlike Jackson's, are always a delight to read:

   
Studies in Neurology. 2
vols. Oxford: 1920.

   
Aphasia and Kindred Disorders of Speech. 2
vols. Cambridge: 1926.

   
Kurt Goldstein

   Goldstein's most accessible general book is
Der Aufbau des Organis-mus
(The Hague: 1934), translated as
The Organism: A Holistic Approach to Biology Derived from Pathological Data in Man
(New York: 1939). See also Goldstein, K. and Sheerer, M., "Abstract amp; concrete behaviour,"
Psychol. Monogr.
53 (1941).

   Goldstein's fascinating case-histories, scattered through many books and journals, await collection.

   
A. R. Luria

   The greatest neurological treasure of our time, for both thought and case description, is the works of A. R. Luria. Most of Luria's books have been translated into English. The most accessible are:

   
The Man with a Shattered World.
New York: 1972.
The Mind of a Mnemonist.
New York: 1968.

   
Speech amp; the Development of Mental Processes in the Child.
London: 1959. A study of mental defect, speech, play, and twins.

   
Human Brain and Psychological Process.
New York: 1966. Case histories of patients with frontal lobe syndromes.

   
The Neuropsychology of Memory.
New York: 1976.

   
Higher Cortical Functions in Man.
2nd ed. New York: 1980. Luria's magnum opus-the greatest synthesis of neurological work and thought in our century.

   
The Working Brain.
Harmondsworth: 1973. A condensed and highly readable version of the above. The best available introduction to neuropsychology.

   
CHAPTER REFERENCES

   
1. The Man Who Mistook His Wife for a Hat