That first week Christina did nothing, lay passively, scarcely ate. She was in a state of utter shock, horror and despair. What sort of a life would it be, if there was not natural recovery? What sort of a life, every move made by artifice? What sort of a life, above all, if she felt disembodied?
Then life reasserted itself, as it will, and Christina started to move. She could at first do nothing without using her eyes, and collapsed in a helpless heap the moment she closed them. She had, at first, to monitor herself by vision, looking carefully at each part of her body as it moved, using an almost painful conscientiousness and care. Her movements, consciously monitored and regulated, were at first clumsy, artificial, in the highest degree. But then—and here both of us found ourselves most happily surprised, by the power of an ever-increasing, daily increasing, automatism—then her movements started to appear more delicately modulated, more graceful, more natural (though still wholly dependent on use of the eyes).
Increasingly now, week by week, the normal, unconscious feedback of proprioception was being replaced by an equally unconscious feedback by vision, by visual automatism and reflexes increasingly integrated and fluent. Was it possible, too, that something more fundamental was happening? That the brain’s visual model of the body, or body-image—normally rather feeble (it is, of course, absent in the blind), and normally subsidiary to the proprioceptive body-model—was it possible that this, now the proprioceptive body model was lost, was gaining, by way of compensation or substitution, an enhanced, exceptional, extraordinary force? And to this might be added a compensatory enhancement of the vestibular body-model or body-image, too . . . both to an extent which was more than we had expected or hoped for.[9]
Whether or not there was increased use of vestibular feedback, there was certainly increased use of her ears—auditory feedback. Normally this is subsidiary, and rather unimportant in speaking— our speech remains normal if we are deaf from a head cold, and some of the congenitally deaf may be able to acquire virtually perfect speech. For the modulation of speech is normally proprioceptive, governed by inflowing impulses from all our vocal organs. Christina had lost this normal inflow, this afference, and lost her normal proprioceptive vocal tone and posture, and there-tore had to use her ears, auditory feedback, instead.
Besides these new, compensatory forms of feedback, Christina also started to develop—it was deliberate and conscious in the first place, but gradually became unconscious and automatic—various forms of new and compensatory ‘feed-forward’ (in all this she was assisted by an immensely understanding and resourceful rehabilitative staff).
Thus at the time of her catastrophe, and for about a month afterwards, Christina remained as floppy as a ragdoll, unable even to sit up. But three months later, I was startled to see her sitting very finely—too finely, statuesquely, like a dancer in mid-pose. And soon I saw that her sitting was, indeed, a pose, consciously or automatically adopted and sustained, a sort of forced or wilful or histrionic posture, to make up for the continuing lack of any genuine, natural posture. Nature having failed, she took to ‘artifice’, but the artifice was suggested by nature, and soon became ‘second nature’. Similarly with her voice—she had at first been almost mute.
This too was projected, as to an audience from a stage. It was a stagey, theatrical voice—not because of any histrionism, or perversion of motive, but because there was still no natural vocal posture. And with her face, too—this still tended to remain somewhat flat and expressionless (though her inner emotions were of full and normal intensity), due to lack of proprioceptive facial tone and posture,[10] unless she used an artificial enhancement of expression (as patients with aphasia may adopt exaggerated emphases and inflections).
But all these measures were, at best, partial. They made life possible—they did not make it normal. Christina learned to walk, to take public transport, to conduct the usual business of life—but only with the exercise of great vigilance, and strange ways of doing things—ways which might break down if her attention was diverted. Thus if she was eating while she was talking, or if her attention was elsewhere, she would grip the knife and fork with painful force—her nails and fingertips would go bloodless with pressure; but if there was any lessening of the painful pressure, she might nervelessly drop them straightaway—there was no in-between, no modulation, whatever.
Thus, although there was not a trace of neurological recovery (recovery from the anatomical damage to nerve fibres), there was, with the help of intensive and varied therapy—she remained in hospital, on the rehabilitation ward, for almost a year—a very considerable functional recovery, i.e., the ability to function using various substitutions and other such tricks. It became possible, finally, for Christina to leave hospital, go home, rejoin her children. She was able to return to her home-computer terminal, which she now learned to operate with extraordinary skill and efficiency, considering that everything had to be done by vision, not feel. She had learned to operate—but how did she feel? Had the substitutions dispersed the disembodied sense she first spoke of?
The answer is—not in the least. She continues to feel, with the continuing loss of proprioception, that her body is dead, not-real, not-hers—she cannot appropriate it to herself. She can find no words for this state, and can only use analogies derived from other senses: ‘I feel my body is blind and deaf to itself ... it has no sense of itself’—these are her own words. She has no words, no direct words, to describe this bereftness, this sensory darkness (or silence) akin to blindness or deafness. She has no words, and we lack words too. And society lacks words, and sympathy, for such states. The blind, at least, are treated with solicitude—we can imagine their state, and we treat them accordingly. But when Christina, painfully, clumsily, mounts a bus, she receives nothing but uncomprehending and angry snarls: ‘What’s wrong with you, lady? Are you blind—or blind-drunk?’ What can she answer—‘I have no proprioception’? The lack of social support and sympathy is an additional triaclass="underline" disabled, but with the nature of her disability not clear—she is not, after all, manifestly blind or paralysed, manifestly anything—she tends to be treated as a phoney or a fool. This is what happens to those with disorders of the hidden senses (it happens also to patients who have vestibular impairment, or who have been labyrinthectomised).
Christina is condemned to live in an indescribable, unimaginable realm—though ‘non-realm’, ‘nothingness’, might be better words for it. At times she breaks down—not in public, but with me: ‘If only I could feel!’ she cries. ‘But I’ve forgotten what it’s like ... I was normal, wasn’t I? I did move like everyone else?’
‘Yes, of course.’
‘There’s no “of course”. I can’t believe it. I want proof.’
I show her a home movie of herself with her children, taken just a few weeks before her polyneuritis.
‘Yes, of course, that’s me!’ Christina smiles, and then cries: ‘But I can’t identify with that graceful girl any more! She’s gone, I can’t remember her, I cant even imagine her. It’s like something’s been scooped right out of me, right at the centre . . . that’s what they do with frogs, isn’t it? They scoop out the centre, the spinal cord, they pith them . . . That’s what I am, pithed, like a frog . . . Step up, come and see Chris, the first pithed human being. She’s no proprioception, no sense of herself—disembodied Chris, the pithed girl!’ She laughs wildly, with an edge of hysteria. I calm her— ‘Come now!’—while thinking, ‘Is she right?’
9
Contrast the fascinating case described by the late Purdon Martin in The Basal Ganglia and Posture (1967), p. 32: ‘This patient, in spite of years of physiotherapy and training, has never regained the ability to walk in any normal manner. His greatest difficulty is in starting to walk and in propelling himself forward ... He is also unable to rise from a chair. He cannot crawl or place himself in the all-fours posture. When standing or walking he is entirely dependent on vision and falls down if he closes his eyes. At first he was unable to maintain his position on an ordinary chair when he closed his eyes, but he has gradually acquired the ability to do this.’
10
Purdon Martin, almost alone of contemporary neurologists, would often speak of facial and vocal ‘posture’, and their basis, finally, in proprioceptive integrity. He was greatly intrigued when 1 told him about Christina and showed him some films and tapes of her—many of the suggestions and formulations here are, in fact, his.