The super-Touretter, then, is compelled to fight, as no one else is, simply to survive—to become an individual, and survive as one, in face of constant impulse. He may be faced, from earliest childhood, with extraordinary barriers to individuation, to becoming a real person. 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. Health, health militant, is usually the victor.
PART THREE. TRANSPORTS
Introduction
While we have criticised the concept of function, even attempting a rather radical redefinition, we have adhered to it nevertheless, drawing in the broadest terms contrasts based on ‘deficit’ or ‘excess’. But it is clear that wholly other terms also have to be used. As soon as we attend to phenomena as such, to the actual quality of experience or thought or action, we have to use terms more reminiscent of a poem or painting. How, say, is a dream intelligible in terms of function?
We have always two universes of discourse—call them ‘physical’ and ‘phenomenal’, or what you will—one dealing with questions of quantitative and formal structure, the other with those qualities that constitute a ‘world’. All of us have our own, distinctive mental worlds, our own inner journeyings and landscapes, and these, for most of us, require no clear neurological ‘correlate’. We can usually tell a man’s story, relate passages and scenes from his life, without bringing in any physiological or neurological considerations: such considerations would seem, at the least, supererogatory, if not frankly absurd or insulting. For we consider ourselves, and rightly, ‘free’—at least, determined by the most complex human and ethical considerations, rather than by the vicissitudes of our neural functions or nervous systems. Usually, but not always: for sometimes a man’s life may be cut across, transformed, by an organic disorder; and if so his story does require a physiological or neurological correlate. This, of course, is so with all the patients here described.
In the first half of this book we described cases of the obviously pathological—situations in which there is some blatant neurological excess or deficit. Sooner or later it is obvious to such patients, or their relatives, no less than to their doctors, that there is ‘something (physically) the matter’. Their inner worlds, their dispositions, may indeed be altered, transformed; but, as becomes clear, this is due to some gross (and almost quantitative) change in neural function. In this third section, the presenting feature is reminiscence, altered perception, imagination, ‘dream’. Such matters do not often come to neurological or medical notice. Such ‘transports’—often of poignant intensity, and shot through with personal feeling and meaning—tend to be seen, like dreams, as psychicaclass="underline" as a manifestation, perhaps, of unconscious or preconscious activity (or, in the mystically-minded, of something ‘spiritual’), not as something ‘medical’, let alone ‘neurological’. They have an intrinsic dramatic, or narrative, or personal ‘sense’, and so are not apt to be seen as ‘symptoms’. It may be in the nature of transports that they are more likely to be confided to psychoanalysts or confessors, to be seen as psychoses, or to be broadcast as religious revelations, rather than brought to physicians. For it never occurs to us at first that a vision might be ‘medical’; and if an organic basis is suspected or found, this may be felt to ‘devalue’ the vision (though, of course, it does not—values, valuations, have nothing to do with etiology).
All the transports described in this section do have more or less clear organic determinants (though it was not evident to begin with, but required careful investigation to bring out). This does not detract in the least from their psychological or spiritual significance. If God, or the eternal order, was revealed to Dostoievski in seizures, why should not other organic conditions serve as ‘portals’ to the beyond or the unknown? In a sense, this section is a study of such portals.
Hughlings Jackson, in 1880, describing such ‘transports’, or ‘portals’, or ‘dreamy states’, in the course of certain epilepsies, used the general word ‘reminiscence’. He wrote:
I should never diagnose epilepsy from the paroxysmal occurrence of ‘reminiscence’, without other symptoms, although I should suspect epilepsy if that super-positive mental state began to occur very frequently ... I have never been consulted for ‘reminiscence’ only . . .
But J have been so consulted: for the forced or paroxysmal reminiscence of tunes, of ‘visions’, of ‘presences’, or scenes—not only in epilepsy, but in a variety of other organic conditions. Such transports or reminiscences are not uncommon in migraine (see ‘The Visions of Hildegard’, Chapter Twenty). This sense of ‘going back’, whether on an epileptic or toxic basis, suffuses ‘A Passage to India’ (Chapter Seventeen). A plainly toxic or chemical basis underlies ‘Incontinent Nostalgia’ (Chapter Sixteen) and the strange hyperosmia of Chapter Eighteen, ‘The Dog Beneath the Skin’. Either seizure-activity or a frontal-lobe disinhibition determines the horrifying ‘reminiscence’ of ‘Murder’ (Chapter Nineteen).
The theme of this section is the power of imagery and memory to ‘transport’ a person as a result of abnormal stimulation of the temporal lobes and limbic system of the brain. This may even teach us something of the cerebral basis of certain visions and dreams, and of how the brain (which Sherrington called ‘an enchanted loom’) may weave a magic carpet to transport us.
15. Reminiscence
Mrs O’C. was somewhat deaf, but otherwise in good health. She lived in an old people’s home. One night, in January 1979, she dreamt vividly, nostalgically, of her childhood in Ireland, and especially of the songs they danced to and sang. When she woke up, the music was still going, very loud and clear. ‘I must still be dreaming,’ she thought, but this was not so. She got up, roused and puzzled. It was the middle of the night. Someone, she assumed, must have left a radio playing. But why was she the only person to be disturbed by it? She checked every radio she could find—they were all turned off. Then she had another idea: she had heard that dental fillings could sometimes act like a crystal radio, picking up stray broadcasts with unusual intensity. ‘That’s it,’ she thought. ‘One of my fillings is playing up. It won’t last long. I’ll get it fixed in the morning.’ She complained to the night nurse, who said her fillings looked fine. At this point another notion occurred to Mrs O’C: ‘What sort of radio-station,’ she reasoned to herself, ‘would play Irish songs, deafeningly, in the middle of the night? Songs, just songs, without introduction or comment? And only songs that I know. What radio station would play my songs, and nothing else?’ At this point she asked herself: ‘Is the radio in my head?’
She was now thoroughly rattled—and the music continued deafening. Her last hope was her ENT man, the otologist she was seeing: he would reassure her, tell her it was just ‘noises in the ear’, something to do with her deafness, nothing to worry about. But when she saw him in the course of the morning, he said: ‘No, Mrs O’C., I don’t think it’s your ears. A simple ringing or buzzing or rumbling, maybe: but a concert of Irish songs—that’s not your ears. Maybe,’ he continued, ‘you should see a psychiatrist.’ Mrs O’C. arranged to see a psychiatrist the same day. ‘No, Mrs O’C.,’ the psychiatrist said, ‘it’s not your mind. You are not mad—and the mad don’t hear music, they only hear “voices”. You must see a neurologist, my colleague, Dr Sacks.’ And so Mrs O’C. came to me.