Stimulate a point in the cortex of such a patient, and there convulsively unrolls a Proustian evocation or reminiscence. What mediates this, we wonder? What sort of cerebral organisation could allow this to happen? Our current concepts of cerebral processing and representation are all essentially computational (see, for example, David Marr’s brilliant book, Vision: A Computational Investigation of Visual Representation in Man, 1982). And, as such, they are couched in terms of ‘schemata’, ‘programmes’, ‘algorithms’, etc.
But could schemata, programmes, algorithms alone provide for us the richly visionary, dramatic and musical quality of experience—that vivid personal quality which makes it ‘experience’?
The answer is clearly, even passionately, ‘No!’ Computational representations—even of the exquisite sophistication envisaged by Marr and Bernstein (the two greatest pioneers and thinkers in this realm)—could never, of themselves, constitute ‘iconic’ representations, those representations which are the very thread and stuff of life.
Thus a gulf appears, indeed a chasm, between what we learn from our patients and what physiologists tell us. Is there any way of bridging this chasm? Or, if that is (as it may be) categorically impossible, are there any concepts beyond those of cybernetics by which we may better understand the essentially personal, Proustian nature of reminiscence of the mind, of life? Can we, in short, have a personal or Proustian physiology, over and above the mechanical, Sherringtonian one? (Sherrington himself hints at this in Man on His Nature (1940), when he imagines the mind as ‘an enchanted loom’, weaving ever-changing yet always meaningful patterns—weaving, in effect, patterns of meaning . . . )
Such patterns of meaning would indeed transcend purely formal or computational programmes or patterns, and allow the essentially personal quality which is inherent in reminiscence, inherent in all mnesis, gnosis, and praxis. And if we ask what form, what organisation, such patterns could have, the answer springs immediately (and, as it were, inevitably) to mind. Personal patterns, patterns for the individual, would have to take the form of scripts or scores—as abstract patterns, patterns for a computer, must take the form of schemata or programmes. Thus, above the level of cerebral programmes, we must conceive a level of cerebral scripts and scores.
The score of ‘Easter Parade’, I conjecture, is indelibly inscribed in Mrs O’M.‘s brain—the score, her score, of all she heard and felt at the original moment and imprinting of the experience. Similarly, in the ‘dramaturgic’ portions of Mrs O’C.’s brain, apparently forgotten, but none the less totally recoverable, must have lain, indelibly inscribed, the script of her dramatic, childhood scene.
And let us note, from Penfield’s cases, that the removal of the minute, convulsing point of cortex, the irritant focus causing reminiscence, can remove in toto the iterating scene, and replace an absolutely specific reminiscence or ‘hyper-mnesia’ by an equally specific oblivion or amnesia. There is something extremely important, and frightening here: the possibility of a real psycho-surgery, a neurosurgery of identity (infinitely finer and more specific than our gross amputations and lobotomies, which may damp or deform the whole character, but cannot touch individual experiences).
Experience is not possible until it is organised iconically; action is not possible unless it is organised iconically. ‘The brain’s record’ of everything—everything alive—must be iconic. This is the final form of the brain’s record, even though the preliminary form may be computational or programmatic. The final form of cerebral representation must be, or allow, ‘art’—the artful scenery and melody of experience and action.
By the same token, if the brain’s representations are damaged or destroyed, as in the amnesias, agnosias, apraxias, their recon-stitution (if possible) demands a double approach—an attempt to reconstruct damaged programs and systems—as is being developed, extraordinarily, by Soviet neuropsychology; or a direct approach at the level of inner melodies and scenes (as described in Awakenings, A Leg to Stand On and several cases in this book, especially ‘Rebecca’ (Chapter Twenty-one) and the introduction to Part Four). Either approach may be used—or both may be used in conjunction—if we are to understand, or assist, brain-damaged patients: a ‘systematic’ therapy, and an ‘art’ therapy, preferably both.
All of this was hinted at a hundred years ago—in Hughlings Jackson’s original account of ‘reminiscence’ (1880); by Korsakoff, on amnesia (1887); and by Freud and Anton in the 1890s, on agnosias. Their remarkable insights have been half-forgotten, eclipsed by the rise of a systematic physiology. Now is the time to recall them, re-use them, so that there may arise, in our own time, a new and beautiful ‘existential’ science and therapy, which can join with the systematic, to give us a comprehensive understanding and power.
Since the original publication of this book I have been consulted for innumerable cases of musical ‘reminiscence’—it is evidently not uncommon, especially in the elderly, though fear may inhibit the seeking of advice. Occasionally (as with Mrs. O’C. and O’M.) a serious or significant pathology is found. Occasionally—as in a recent case report (NE/M, September 5, 1985)—there is a toxic basis, such as the over-use of aspirin. Patients with severe nerve-deafness may have musical ‘phantoms’. But in most cases no pathology can be found, and the condition, though a nuisance, is essentially benign. (Why the musical parts of the brain, above all, should be so prone to such ‘releases’ in old age remains far from clear.)
16. Incontinent Nostalgia
If I encountered ‘reminiscence’ occasionally in the context of epilepsy or migraine, I encountered it commonly in my post-ence-phalitic patients excited by L-Dopa—so much so that I found myself calling L-Dopa ‘a sort of strange and personal time-machine’. It was so dramatic in one patient that I made her the subject of a Letter to the Editor, published in the Lancet in June 1970, and reprinted below. Here, I found myself thinking of ‘reminiscence’ in its strict, Jacksonian sense, as a convulsive upsurge of memories from the remote past. Later, when I came to write the history of this patient (Rose R.) in Awakenings, I thought less in terms of ‘reminiscence’ and more in terms of ‘stoppage’ (‘Has she never moved on from 1926?’ I wrote)—and these are the terms in which Harold Pinter portrays ‘Deborah’ in A Kind of Alaska.
One of the most astonishing effects of L-Dopa, when given to certain postencephalitic patients, is the reactivation of symptoms and behaviour-patterns present at a much earlier stage of the disease, but subsequently ‘lost’. We have already commented, in this connection, on the exacerbation or recurrence of respiratory crises, oculogyric crises, iterative hyperkineses, and tics. We have also observed the reactivation of many other ‘dormant’, primitive symptoms, such as myoclonus, bulimia, polydipsia, satyriasis, central pain, forced affects, etc. At still higher levels of function, we have seen the return and reactivation of elaborate, affectively charged moral postures, thought-systems, dreams, and memories—all ‘forgotten’, repressed, or otherwise inactivated in the limbo of profoundly akinetic, and sometimes apathetic, postencephalitic illness.