The man who mistook his wife for a hat (6 page)

   We did various tests on him (EEG, brain scans), and found no evidence of massive brain damage, although atrophy of the tiny mammillary bodies would not show up on such tests. We received reports from the navy indicating that he had remained in the navy until 1965, and that he was perfectly competent at that time.

   Then we turned up a short nasty report from Bellevue Hospital, dated 1971, saying that he was 'totally disoriented . . . with an advanced organic brain-syndrome, due to alcohol' (cirrhosis had also developed by this time). From Bellevue he was sent to a wretched dump in the Village, a so-called 'nursing home' whence he was rescued-lousy, starving-by our Home in 1975.

   We located his brother, whom Jimmie always spoke of as being in accountancy school and engaged to a girl from Oregon. In fact

   *In his fascinating oral history
The Good War
(1985) Studs Terkel transcribes countless stories of men and women, especially fighting men, who felt World War II was intensely real-by far the most real and significant time of their lives-everything since as pallid in comparison. Such men tend to dwell on the war and to relive its battles, comradeship, moral certainties and intensity. But this dwelling on the past and relative hebetude towards the present-this emotional dulling of current feeling and memory-is nothing like Jimmie's organic amnesia. 1 recently had occasion to discuss the question with Terkel: 'I've met thousands of men,' he told me, 'who feel they've just been "marking time" since '45-but I never met anyone for whom time terminated, like your amnesiac Jimmie.'

   he had married the girl from Oregon, had become a father and grandfather, and been a practising accountant for thirty years.

   Where we had hoped for an abundance of information and feeling from his brother, we received a courteous but somewhat meagre letter. It was obvious from reading this-especially reading between the lines-that the brothers had scarcely seen each other since 1943, and gone separate ways, partly through the vicissitudes of location and profession, and partly through deep (though not estranging) differences of temperament. Jimmie, it seemed, had never 'settled down', was 'happy-go-lucky', and 'always a drinker'. The navy, his brother felt, provided a structure, a life, and the real problems started when he left it, in 1965. Without his habitual structure and anchor Jimmie had ceased to work, 'gone to pieces,' and started to drink heavily. There had been some memory impairment, of the Korsakov type, in the middle and especially the late Sixties, but not so severe that Jimmie couldn't 'cope' in his nonchalant fashion. But his drinking grew heavier in 1970.

   Around Christmas of that year, his brother understood, he had suddenly 'blown his top' and become deliriously excited and confused, and it was at this point he had been taken into Bellevue. During the next month, the excitement and delirium died down, but he was left with deep and bizarre memory lapses, or 'deficits,' to use the medical jargon. His brother had visited him at this time-they had not met for twenty years-and, to his horror, Jimmie not only failed to recognise him, but said, 'Stop joking! You're old enough to be my father. My brother's a young man, just going through accountancy school.'

   When I received this information, I was more perplexed still: why did Jimmie not remember his later years in the navy, why did he not recall and organise his memories until 1970? I had not heard then that such patients might have a retrograde amnesia (see Postscript). 'I wonder, increasingly,' I wrote at this time, 'whether there is not an element of hysterical or fugal amnesia-whether he is not in flight from something too awful to recall', and I suggested he be seen by our psychiatrist. Her report was searching and detailed-the examination had included a sodium amytal test, calculated to 'release' any memories which might be repressed.

   She also attempted to hypnotize Jimmie, in the hope of eliciting memories repressed by hysteria-this tends to work well in cases of hysterical amnesia. But it failed because Jimmie 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. (Dr M. Homonoff, who worked on the amnesia ward at the Boston Veterans Administration hospital, tells me of similar experiences-and of his feeling that this is absolutely characteristic of patients with Korsakov's, as opposed to patients with hysterical amnesia.)

   'I have no feeling or evidence,' the psychiatrist wrote, 'of any hysterical or "put-on" deficit. He lacks both the means and the motive to make a facade. His memory deficits are organic and permanent and incorrigible, though it is puzzling they should go back so long.' Since, she felt, he was 'unconcerned . . . manifested no special anxiety . . . constituted no management problem,' there was nothing she could offer, or any therapeutic 'entrance' or 'lever' she could see.

   At this point, persuaded that this was, indeed, 'pure' Korsakov's, uncomplicated by other factors, emotional or organic, I wrote to Luria and asked his opinion. He spoke in his reply of his patient Bel,* whose amnesia had retroactively eradicated ten years. He said he saw no reason why such a retrograde amnesia should not thrust backward decades, or almost a whole lifetime. 'I can only wait for the final amnesia,' Buriuel writes, 'the one that can erase an entire life.' But Jimmies amnesia, for whatever reason, had erased memory and time back to 1945-roughly-and then stopped. Occasionally, he would recall something much later, but the recall was fragmentary and dislocated in time. Once, seeing the word 'satellite' in a newspaper headline, he said offhandedly that he'd been involved in a project of satellite tracking while on the ship
Chesapeake Bay,
a memory fragment coming from the early or mid-Sixties. But, for all practical purposes, his cut-off point was during the mid- (or late) Forties, and anything subsequently re-

   *See A.R. Luria,
The Neuropsychology of Memory
(1976), pp. 250-2.

   trieved was fragmentary, unconnected. I his was the case in 1975, and it is still the case now, nine years later.

   What could we do? What should we do? There are no prescriptions,' Luria wrote, 'in a case like this. Do whatever your ingenuity and your heart suggest. There is little or no hope of any recovery in his memory. But a man does not consist of memory alone. He has feeling, will, sensibilities, moral being-matters of which neuropsychology cannot speak. And it is here, beyond the realm of an impersonal psychology, that you may find ways to touch him, and change him. And the circumstances of your work especially allow this, for you work in a Home, which is like a little world, quite different from the clinics and institutions where I work. Neuropsychological!}', there is little or nothing you can do; but in the realm of the Individual, there may be much you can do.'

   Luria mentioned his patient Kur as manifesting a rare self-awareness, in which hopelessness was mixed with an odd equanimity. 'I have no memory of the present,' Kur would say. 'I do not know what I have just done or from where I have just come … I can recall my past very well, but I have no memory of my present.' When asked whether he had ever seen the person testing him, he said, 'I cannot say yes or no, I can neither affirm nor deny that I have seen you.' This was sometimes the case with Jimmie; and, like Kur, who stayed many months in the same hospital, Jimmie began to form 'a sense of familiarity'; he slowly learned his way around the home-the whereabouts of the dining room, his own room, the elevators, the stairs, and in some sense recognised some of the staff, although he confused them, and perhaps had to do so, with people from the past. He soon became fond of the nursing sister in the Home; he recognised her voice, her footfalls, immediately, but would always say that she had been a fellow pupil at his high school, and was greatly surprised when I addressed her as 'Sister'.

   'Gee!' he exclaimed, 'the damnedest things happen. I'd never have guessed you'd become a religious, Sister!'

   Since he's been at our Home-that is, since early 1975-Jimmie has never been able to identify anyone in it consistently. The

   only person he truly recognises is his brother, whenever he visits from Oregon. These meetings are deeply emotional and moving to observe-the only truly emotional meetings Jimmie has. He loves his brother, he recognises him, but he cannot understand why he looks so old: 'Guess some people age fast,' he says. Actually his brother looks much younger than his age, and has the sort of face and build that change little with the years. These are true meetings, Jimmie's only connection of past and present, yet they do nothing to provide any sense of history or continuity. If anything they emphasise-at least to his brother, and to others who see them together-that Jimmie still lives, is fossilised, in the past.

   All of us, at first, had high hopes of helping Jimmie-he was so personable, so likable, so quick and intelligent, it was difficult to believe that he might be beyond help. But none of us had ever encountered, 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.

   I suggested, when I first saw him, that he should keep a diary, and be encouraged to keep notes every day of his experiences, his feelings, thoughts, memories, reflections. These attempts were foiled, at first, by his continually losing the diary: it had to be attached to him-somehow. But this too failed to work: he dutifully kept a brief daily notebook but could not recognise his earlier entries in it. He does recognise his own writing, and style, and is always astounded to find that he wrote something the day before.

   Astounded-and indifferent-for he was a man who, in effect, had no 'day before'. His entries remained unconnected and un-connecting and had no power to provide any sense of time or continuity. Moreover, they were trivial-'Eggs for breakfast', 'Watched ballgame on TV-and never touched the depths. But were there depths in this unmemoried man, depths of an abiding feeling and thinking, or had he been reduced to a sort of Humean drivel, a mere succession of unrelated impressions and events?

   Jimmie both was and wasn't aware of this deep, tragic loss in himself, loss
of
himself. (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.) Therefore I could not question him intellectually about such matters.

   He had originally professed bewilderment at finding himself amid patients, when, as he said, he himself didn't feel ill. But what, we wondered, did he feel? He was strongly built and fit, he had a sort of animal strength and energy, but also a strange inertia, passivity, and (as everyone remarked) 'unconcern'; he gave all of us an overwhelming sense of'something missing,' although this, if he realised it, was itself accepted with an odd 'unconcern.' One day I asked him not about his memory, or past, but about the simplest and most elemental feelings of all:

   'How do you feel?'

   'How do I feel,' he repeated, and scratched his head. 'I cannot say I feel ill. But I cannot say I feel well. I cannot say I feel anything at all.'

   'Are you miserable?' I continued.

   'Can't say I am.'

   'Do you enjoy life?'

   'I can't say I do … '

   I hesitated, fearing that I was going too far, that I might be stripping a man down to some hidden, unacknowledgeable, unbearable despair.

   'You don't enjoy life,' I repeated, hesitating somewhat. 'How then
do
you feel about life?'

   'I can't say that I feel anything at all.'

   'You feel alive though?'

   'Feel alive? Not really. I haven't felt alive for a very long time.'

   His face wore a look of infinite sadness and resignation.

   Later, having noted his aptitude for, and pleasure in, quick games and puzzles, and their power to 'hold' him, at least while they lasted, and to allow, for a while, a sense of companionship and competition-he had not complained of loneliness, but he looked so alone; he never expressed sadness, but he looked so sad- I suggested he be brought into our recreation programs at the Home. This worked better-better than the diary. He would become keenly and briefly involved in games, but soon they ceased

   to offer any challenge: he solved all the puzzles, and could solve them easily; and he was far better and sharper than anyone else at games. And as he found this out, he grew fretful and restless again, and wandered the corridors, uneasy and bored and with a sense of indignity-games and puzzles were for children, a diversion. Clearly, passionately, he wanted something to do: he wanted to do, to be, to feel-and could not; he wanted sense, he wanted purpose-in Freud's words, 'Work and Love'.

   Could he do 'ordinary' work? He had 'gone to pieces', his brother said, when he ceased to work in 1965. He had two striking skills- Morse code and touch-typing. We could not use Morse, unless we invented a use; but good typing we could use, if he could recover his old skills-and this would be real work, not just a game. Jimmie soon did recover his old skill and came to type very quickly-he could not do it slowly-and found in this some of the challenge and satisfaction of a job. But still this was superficial tapping and typing; it was trivial, it did not reach to the depths. And what he typed, he typed mechanically-he could not hold the thought-the short sentences following one another in a meaningless order.

   One tended to speak of him, instinctively, as a spiritual casualty-a 'lost soul': was it possible that he had really been 'de-souled' by a disease? 'Do you think he
has
a soul?' I once asked the Sisters. They were outraged by my question, but could see why I asked it. 'Watch Jimmie in chapel,' they said, 'and judge for yourself

   I did, and I was moved, profoundly moved and impressed, because I saw here an intensity and steadiness of attention and concentration that I had never seen before in him or conceived him capable of. I watched him kneel and take the Sacrament on his tongue, and could not doubt the fullness and totality of Communion, the perfect alignment of his spirit with the spirit of the Mass. Fully, intensely, quietly, in the quietude of absolute concentration and attention, he entered and partook of the Holy Communion. He was wholly held, absorbed, by a feeling. There was no forgetting, no Korsakov's then, nor did it seem possible or imaginable that there should be; for he was no longer at the mercy