Thus, in one patient under my care, a sudden thrombosis in the posterior circulation of the brain caused the immediate death of the visual parts of the brain. Forthwith this patient became completely blind—but did not know it. He looked blind—but he made no complaints. Questioning and testing showed, beyond doubt, that not only was he centrally or ‘cortically’ blind, but he had lost all visual images and memories, lost them totally—yet had no sense of any loss. Indeed, he had lost the very idea of seeing—and was not only unable to describe anything visually, but bewildered when I used words such as ‘seeing’ and ‘light.’ He had become, in essence, a non-visual being. His entire lifetime of seeing, of visuality, had, in effect, been stolen. His whole visual life had, indeed, been erased—and erased permanently in the instant of his stroke. Such a visual amnesia, and (so to speak) blindness to the blindness, amnesia for the amnesia, is in effect a ‘total’ Korsakov’s, confined to visuality.
A still more limited, but none the less total, amnesia may be displayed with regard to particular forms of perception, as in the last chapter, ‘The Man Who Mistook His Wife for a Hat’. There there was an absolute ‘prosopagnosia’, or agnosia for faces. This patient was not only unable to recognise faces, but unable to imagine or remember any faces—he had indeed lost the very idea of a ‘face’, as my more afflicted patient had lost the very ideas of ‘seeing’ or ‘light.’ Such syndromes were described by Anton in the 1890s. But the implication of these syndromes—Korsakov’s and Anton’s—what they entail and must entail for the world, the lives, the identities of affected patients, has been scarcely touched on even to this day.
In Jimmie’s case, we had sometimes wondered how he might respond if taken back to his home town—in effect, to his pre-amnesia days— but the little town in Connecticut had become a booming city with the years. Later I did have occasion to find out what might happen in such circumstances, though this was with another patient with Korsakov’s, Stephen R., who had become acutely ill in 1980 and whose retrograde amnesia went back only two years or so. With this patient, who also had severe seizures, spasticity and other problems necessitating in-patient care, rare weekend visits to his home revealed a poignant situation. In hospital he could recognise nobody and nothing, and was in an almost ceaseless frenzy of disorientation. But when his wife took him home, to his house which was in effect a ‘time-capsule’ of his pre-amnesia days, he felt instantly at home. He recognised everything, tapped the barometer, checked the thermostat, took his favourite armchair, as he used to do. He spoke of neighbours, shops, the local pub, a nearby cinema, as they had been in the mid-Seventies. He was distressed and puzzled if the smallest changes were made in the house. (‘You changed the curtains today!’ he once expostulated to his wife. ‘How come? So suddenly? They were green this morning.’ But they had not been green since 1978.) He recognised most of the neighbouring houses and shops—they had changed little between 1978 and 1983—but was bewildered by the ‘replacement’ of the cinema (‘How could they tear it down and put up a supermarket overnight?’). He recognised friends and neighbours—but found them oddly older than he expected (‘Old so-and-so! He’s really showing his age. Never noticed it before. How come everyone’s showing their age today?’). But the real poignancy, the horror, would occur when his wife brought him back—brought him, in a fantastic and unaccountable manner (so he felt), to a strange home he had never seen, full of strangers, and then left him. ‘What are you doing?’ he would scream, terrified and confused. ‘What in the hell is this place? What the hell’s going on?’ These scenes were almost unbearable to watch, and must have seemed like madness, or nightmare, to the patient. Mercifully perhaps he would forget them within a couple of minutes.
Such patients, fossilised in the past, can only be at home, oriented, in the past. Time, for them, has come to a stop. I hear Stephen R. screaming with terror and confusion when he returns—screaming for a past which no longer exists. But what can we do? Can we create a time-capsule, a fiction? Never have I known a patient so confronted, so tormented, by anachronism, unless it was the ‘Rose R.’ of Awakenings (see ‘Incontinent Nostalgia’, Chapter Sixteen).
Jimmie has reached a sort of calm; William (Chapter Twelve) continually confabulates; but Stephen has a gaping time-wound, an agony that will never heal.
3. The Disembodied Lady
The aspects of things that are most important for us are hidden because of their simplicity and familiarity. (One is unable to notice something because it is always before one’s eyes.) The real foundations of his enquiry do not strike a man at all.
What Wittgenstein writes here, of epistemology, might apply to aspects of one’s physiology and psychology—especially in regard to what Sherrington once called ‘our secret sense, our sixth sense’— that continuous but unconscious sensory flow from the movable parts of our body (muscles, tendons, joints), by which their position and tone and motion are continually monitored and adjusted, but in a way which is hidden from us because it is automatic and unconscious.
Our other senses—the five senses—are open and obvious; but this—our hidden sense—had to be discovered, as it was, by Sherrington, in the 1890s. He named it ‘proprioception’, to distinguish it from ‘exteroception’ and ‘interoception’, and, additionally, because of its indispensability for our sense of ourselves; for it is only by courtesy of proprioception, so to speak, that we feel our bodies as proper to us, as our ‘property’, as our own. (Sherrington 1906, 1940.)
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.
Jonathan Miller produced a beautiful television series, The Body in Question, but the body, normally, is never in question: our bodies are beyond question, or perhaps beneath question—they are simply, unquestionably, there. This unquestionability of the body, its certainty, is, for Wittgenstein, the start and basis of all knowledge and certainty. Thus, in his last book (On Certainty), he opens by saying: ‘If you do know that here is one hand, we’ll grant you all the rest.’ But then, in the same breath, on the same opening page: ‘What we can ask is whether it can make sense to doubt it . . .’; and, a little later, ‘Can I doubt it? Grounds for doubt are lacking!’
Indeed, his book might be titled On Doubt, for it is marked by doubting, no less than affirming. Specifically, he wonders—and one in turn may wonder whether these thoughts were perhaps incited by his working with patients, in a hospital, in the war— he wonders whether there might be situations or conditions which take away the certainty of the body, which do give one grounds to doubt’s one body, perhaps indeed to lose one’s entire body in total doubt. This thought seems to haunt his last book like a nightmare.
Christina was a strapping young woman of twenty-seven, given to hockey and riding, self-assured, robust, in body and mind. She had two young children, and worked as a computer programmer at home. She was intelligent and cultivated, fond of the ballet, and of the Lakeland poets (but not, I would think, of Wittgenstein). She had an active, full life—had scarcely known a day’s illness. Somewhat to her surprise, after an attack of abdominal pain, she was found to have gallstones, and removal of the gallbladder was advised.