But the word ‘It’, or automatism, is also too mechanical. ‘Burgeoning’ conveys better the disquietingly alive quality of the process. We see in the Mnemonist—or in my own overenergised, galvanised patients on L-Dopa—a sort of animation gone extravagant, monstrous, or mad—not merely an excess, but an organic proliferation, a generation; not just an imbalance, a disorder of function, but a disorder of generation.
We might imagine, from a case of amnesia or agnosia, that there is merely a function or competence impaired—but we see from patients with hypermnesias and hypergnosias that mnesis and gnosis are inherently active, and generative, at all times; inherently, and—potentially—monstrously as well. Thus we are forced to move from a neurology of function to a neurology of action, of life. This crucial step is forced upon us by the diseases of excess— and without it we cannot begin to explore the ‘life of the mind’. Traditional neurology, by its mechanicalness, its emphasis on deficits, conceals from us the actual life which is instinct in all cerebral functions—at least higher functions such as those of imagination, memory and perception. It conceals from us the very life of the mind. It is with these living (and often highly personal) dispositions of brain and mind—especially in a state of enhanced, and thus illuminated, activity—that we shall be concerned now.
Enhancement allows the possibilities not only of a healthy fullness and exuberance, but of a rather ominous extravagance, aberration, monstrosity—the sort of ‘too-muchness’ which continually loomed in Awakenings, as patients, over-excited, tended to disintegration and uncontrol; an overpowering by impulse, image and will; possession (or dispossession) by a physiology gone wild.
This danger is built into the very nature of growth and life. Growth can become over-growth, life ‘hyper-life’. All the ‘hyper’ states can become monstrous, perverse aberrations, ‘para’ states: hyperkinesia tends towards parakinesia—abnormal movements, chorea, tics; hypergnosia readily becomes paragnosia—perversions, apparitions, of the morbidly-heightened senses; the ardours of ‘hyper’ states can become violent passions.
The paradox of an illness which can present as wellness—as a wonderful feeling of health and well-being, and only later reveal its malignant potentials—is one of the chimaeras, tricks and ironies of nature. It is one which has fascinated a number of artists, especially those who equate art with sickness: thus it is a theme—at once Dionysiac, Venerean and Faustian—which persistently recurs in Thomas Mann—from the febrile tuberculous highs of The Magic Mountain, to the spirochetal inspirations in Dr Faustus and the aphrodisiac malignancy in his last tale, The Black Swan.
I have always been intrigued by such ironies, and have written of them before. In Migraine I spoke of the high which may precede, or constitute the start of, attacks—and quoted George Eliot’s remark that feeling ‘dangerously well’ was often, for her, the sign or harbinger of an attack. ‘Dangerously well’—what an irony is this: it expresses precisely the doubleness, the paradox, of feeling ‘too well’.
For ‘wellness’, naturally, is no cause for complaint—people relish it, they enjoy it, they are at the furthest pole from complaint. People complain of feeling ill—not well. Unless, as George Eliot does, they have some intimation of ‘wrongness’, or danger, either through knowledge or association, or the very excess of excess. Thus, though a patient will scarcely complain of being ‘very well’, they may become suspicious if they feel ‘too well’.
This was a central, and (so to speak) cruel, theme in Awakenings, that patients profoundly ill, with the profoundest deficits, for many decades, might find themselves, as by a miracle, suddenly well, only to move from there into the hazards, the tribulations, of excess, functions stimulated far beyond ‘allowable’ limits. Some patients realised this, had premonitions—but some did not. Thus Rose R., in the first flush and joy of restored health, said, ‘It’s fabulous, it’s gorgeous!’, but as things accelerated towards uncon-trol said, ‘Things can’t last. Something awful is coming.’ And similarly, with more or less insight, in most of the others—as with Leonard L., as he passed from repletion to excess: ‘his abundance of health and energy—of “grace”, as he called it—became too abundant, and started to assume an extravagant form. His sense of harmony and ease and effortless control was replaced by a sense of too-muchness ... a great surplus, a great pressure of . . . [every kind]’, which threatened to disintegrate him, to burst him asunder.
This is the simultaneous gift and affliction, the delight, the anguish, conferred by excess. And it is felt, by insightful patients, as questionable and paradoxicaclass="underline" ‘I have too much energy,’ one Tourette patient said. ‘Everything is too bright, too powerful, too much. It is a feverish energy, a morbid brilliance.’
‘Dangerous wellness’, ‘morbid brilliance’, a deceptive euphoria with abysses beneath—this is the trap promised and threatened by excess, whether it be set by Nature, in the form of some intoxicating disorder, or by ourselves, in the form of some excitant addiction.
The human dilemmas, in such situations, are of an extraordinary kind: for patients are here faced with disease as seduction, something remote from, and far more equivocal than, the traditional theme of illness as suffering or affliction. And nobody, absolutely nobody, is exempt from such bizarrenesses, such indignities. In disorders of excess there may be a sort of collusion, in which the self is more and more aligned and identified with its sickness, so that finally it seems to lose all independent existence, and be nothing but a product of sickness. This fear is expressed by Witty Ticcy Ray in Chapter Ten when he says: ‘I consist of tics—there is nothing else’, or when he envisages a mind-growth— a ‘Tourettoma’—which might engulf him. For him, with his strong ego, and relatively mild Tourette’s syndrome, there was not, in reality, any such danger. But for patients with weak or undeveloped egos, coupled with overwhelmingly strong disease, there is a very real risk of such ‘possession’ or ‘dispossession’. I do no more than touch on this in ‘The Possessed’.
10. Witty Ticcy Ray
In 1885 Gilles de la Tourette, a pupil of Charcot, described the astonishing syndrome which now bears his name. ‘Tourette’s syndrome’, as it was immediately dubbed, is characterised by an excess of nervous energy, and a great production and extravagance of strange motions and notions: tics, jerks, mannerisms, grimaces, noises, curses, involuntary imitations and compulsions of all sorts, with an odd elfin humour and a tendency to antic and outlandish kinds of play. In its ‘highest’ forms, Tourette’s syndrome involves every aspect of the affective, the instinctual and the imaginative life; in its ‘lower’, and perhaps commoner, forms, there may be little more than abnormal movements and impulsivity, though even here there is an element of strangeness. It was well recognised and extensively reported in the closing years of the last century, for these were years of a spacious neurology which did not hesitate to conjoin the organic and the psychic. It was clear to Tourette, and his peers, that this syndrome was a sort of possession by primitive impulses and urges: but also that it was a possession with an organic basis—a very definite (if undiscovered) neurological disorder.
In the years that immediately followed the publication of Tourette’s original papers many hundreds of cases of this syndrome were described—no two cases ever being quite the same. It became clear that there were forms which were mild and benign, and others of quite terrible grotesqueness and violence. Equally, it was clear that some people could ‘take’ Tourette’s, and accommodate it within a commodious personality, even gaining advantage from the swiftness of thought and association and invention which went with it, while others might indeed be ‘possessed’ and scarcely able to achieve real identity amid the tremendous pressure and chaos of Tourettic impulses. There was always, as Luria remarked of his mnemonist, a fight between an ‘It’ and an T.