The Man Who Mistook His Wife for a Hat and Other Clinical Tales

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.

If we wish to know about a man, we ask 'what is his story--his real, inmost story?'--for each of us is a biography, a story. Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us--through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives--we are each of us unique.

To be ourselves we must have ourselves – possess, if need be re-possess, our life-stories. We must “recollect” ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self.

he wanted to do, to be, to feel- and could not; he wanted sense, he wanted purpose- in Freud's words, 'Work and Love'.

Dangerously well’— what an irony is this: it expresses precisely the doubleness, the paradox, of feeling ‘too well

The miracle is that, in most cases, he succeeds - for the powers of survival, of the will to survive, and to survive as a unique inalienable individual, are absolutely, the strongest in our being: stronger than any impulses, stronger than disease.

Very young children love and demand stories, and can understand complex matters presented as stories, when their powers of comprehending general concepts, paradigms, are almost nonexistent.

But the saddest difference between them was that Zazetsky, as Luria said, 'fought to regain his lost faculties with the indomitable tenacity of the damned,' whereas Dr P. was not fighting, did not know what was lost. But who was more tragic, or who was more damned -- the man who knew it, or the man who did not?

One must go to Dostoievsky who experienced on occasion ecstatic epileptic auras to which he attached momentous significance, to find an adequate historical parallel. "There are moments, and it is only a matter of five or six seconds, when you feel the presence of the eternal harmony ... a terrible thing is the frightful clearness with which it manifests itself and the rapture with which it fills you. If this state were to last more than five seconds, the soul could not endure it and would have to disappear. During these five seconds I live a whole human existence, and for that I would give my whole life and not think that I was paying too dearly …

For here is a man who, in some sense, is desperate, in a frenzy. The world keeps disappearing, losing meaning, vanishing - and he must seek meaning, make meaning, in a desperate way, continually inventing, throwing bridges of meaning over abysses of meaninglessness, the chaos that yawns continually beneath him.

The pleasure we obtain from music comes from counting, but counting unconsciously. Music is nothing but unconscious arithmetic.

Thus the feeling I sometimes have - which all of us who work closely with aphasiacs have - that one cannot lie to an aphasiac. He cannot grasp your words, and cannot be deceived by them; but what he grasps he grasps with infallible precision, namely the expression that goes with the words, the total, spontaneous, involuntary expressiveness which can never be simulated or faked, as words alone can, too easily.

And so was Luria, whose words now came back to me: ‘A man does not consist of memory alone. He has feeling, will, sensibility, moral being ... It is here ... you may touch him, and see a profound change.’ Memory, mental activity, mind alone, could not hold him; but moral attention and action could hold him completely.

But who was more tragic, or who was more damned—the man who knew it, or the man who did not?

The ‘secret’ of Shostakovich, it was suggested—by a Chinese neurologist, Dr Dajue Wang—was the presence of a metallic splinter, a mobile shell-fragment, in his brain, in the temporal horn of the left ventricle. Shostakovich was very reluctant, apparently, to have this removed: Since the fragment had been there, he said, each time he leaned his head to one side he could hear music. His head was filled with melodies—different each time—which he then made use of when composing. X-rays allegedly showed the fragment moving around when Shostakovich moved his head, pressing against his ‘musical’ temporal lobe, when he tilted, producing an infinity of melodies which his genius could use.

Astounded—and indifferent—for he was a man who, in effect, had no ‘day before’.

Perhaps there is a philosophical as well as a clinical lesson here: that in Korsakov’s, or dementia, or other such catastrophes, however great the organic damage and Humean dissolution, there remains the undiminished possibility of reintegration by art, by communion, by touching the human spirit: and this can be preserved in what seems at first a hopeless state of neurological devastation.

We have five senses in which we glory and which we recognise and celebrate, senses that constitute the sensible world for us. But there are other senses -- secret senses, sixth senses, if you will -- equally vital, but unrecognised, and unlauded. These senses, unconscious, automatic, had to be discovered.

I have traversed many kinds of health, and keep traversing them... and as for sickness: are we not almost tempted to ask whether we could get along without it? Only great pain is the liberator of the spirit.

But it must be said from the outset that a disease is never a mere loss or excess— that there is always a reaction, on the part of the affected organism or individual, to restore, to replace, to compensate for and to preserve its identity, however strange the means may be: and to study or influence these means, no less than the primary insult to the nervous system, is an essential part of our role as physicians.

What is more important for us, at an elemental level, than the control, the owning and operation, of our own physical selves? And yet it is so automatic, so familiar, we never give it a thought.

The power of music, narrative and drama is of the greatest practical and theoretical importance. One may see this even in the case of idiots, with IQs below 20 and the extremest motor incompetence and bewilderment. Their uncouth movements may disappear in a moment with music and dancing—suddenly, with music, they know how to move. We see how the retarded, unable to perform fairly simple tasks involving perhaps four or five movements or procedures in sequence, can do these perfectly if they work to music—the sequence of movements they cannot hold as schemes being perfectly holdable as music, i.e. embedded in music. The same may be seen, very dramatically, in patients with severe frontal lobe damage and apraxia—an inability to do things, to retain the simplest motor sequences and programmes, even to walk, despite perfectly preserved intelligence in all other ways. This procedural defect, or motor idiocy, as one might call it, which completely defeats any ordinary system of rehabilitative instruction, vanishes at once if music is the instructor. All this, no doubt, is the rationale, or one of the rationales, of work songs.

judgment is the most important faculty we have. An animal, or a man, may get on very well without ‘abstract attitude’ but will speedily perish if deprived of judgment. Judgment must be the first faculty of higher life or mind—yet it is ignored, or misinterpreted, by classical (computational) neurology. And if we wonder how such an absurdity can arise, we find it in the assumptions, or the evolution, of neurology itself.

There are moments, and it is only a matter of five or six seconds, when you feel the presence of the eternal harmony . . . a terrible thing is the frightful clearness with which it manifests itself and the rapture with which it fills you. If this state were to last more than five seconds, the soul could not endure it and would have to disappear. During these five seconds I live a whole human existence, and for that I would give my whole life and not think that I was paying too dearly . . .